ModerateSelective beta-adrenergic blockers×Angiotensin II receptor blockers (ARBs)
Updated · Methodology
Mechanism
Standard combination in heart failure with reduced ejection fraction. Additive antihypertensive effect and complementary neurohormonal blockade.
Symptoms
On starting, in older or hypovolaemic patients: symptomatic hypotension, dizziness. Bisoprolol bradycardia is amplified.
Management
Start both at minimal doses with up-titration every 2 weeks to target. Check standing/sitting BP, heart rate, creatinine and potassium at 2 weeks. In heart failure, target maximum tolerated doses (bisoprolol up to 10 mg, valsartan up to 320 mg). Outcome evidence base is extensive.
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Sources
- ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– McDonagh TA et al. Eur Heart J 2021;42:3599-3726