title: Tolerability to beta-blocker therapy among heart failure patients in clinical practice.
abstract: BACKGROUND
  Although beta-blockers were well-tolerated by heart failure (HF) patients in clinical trials, tolerability of these drugs in a general population of HF patients is not well-described.
  
  
  METHODS
  We studied a total of 308 encounters with beta-blockers therapy in 268 ambulatory HF patients. Side effects and frequency and predictors of discontinuation of therapy were studied. Independent predictors of discontinuation were assessed.
  
  
  RESULTS
  Weight gain (59%), fatigue (56%), dizziness (41%), and dyspnea (29%) were the most common side effects. Fifty-one patients (19%) were discontinued on therapy with any 1 particular beta-blocker. Fatigue (30%) and hypotension (28%) were the most common reasons for discontinuation. Forty (78%) of these were given a trial with a different beta-blocker. Of these, 22 (55%) attempts with a different beta-blocker were tolerated. Thus the overall absolute discontinuation rate was only 7% for patients who were given a trial with different beta-blockers or 11% for the entire study population. Independent predictors of discontinuation of therapy included advanced symptoms, nonischemic etiology, history of pulmonary disease, and higher diuretic doses.
  
  
  CONCLUSIONS
  Side effects with beta-blockers in a general population of HF patients are common; however, with changes in medical management, most patients can tolerate them eventually. In case of intolerance to one kind, a trial with a different beta-blocker is indicated.
authors.affiliation: Division of Cardiovascular Medicine,Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Ghazanfar
authors.initials: G
authors.lastname: Khadim
authors.forename: Rhonda
authors.initials: R
authors.lastname: Belue
authors.forename: Don
authors.initials: D
authors.lastname: Chomsky
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Marie
authors.initials: M
authors.lastname: Griffin
authors.forename: John R
authors.initials: JR
authors.lastname: Wilson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D000465:Algorithms; D004244:Dizziness / Q000139:chemically induced; D004417:Dyspnea / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D015430:Weight Gain
chemical_list: D000319:Adrenergic beta-Antagonists