[Prescribing beta blockers in elderly patients with heart failure].
Beta blockers remain underused in elderly patients with heart failure. Age is not a contraindication to beta blockers. The SENIORS study confirmed that beta blockers are both efficacious and well tolerated in elderly people with heart failure, regardless of their ejection fraction. Because adverse effects may be both more frequent and more serious in the elderly, prescription protocols must be strictly applied. Patients in stable NYHA stages II or III may begin beta blocker treatment, at least 1 month after any decompensation. The initial dose must be as low as possible (1.25 mg/d for bisoprolol and nebivolol). Doses must be increased very progressively and stages longer than 15 days may be necessary. The objective is to reach the target dose (10mg/d for bisoprolol and nebivolol), given the dose-response effect that exists for beta blockers in elderly people with heart failure. In the case of low blood pressure, antihypertensive treatments must be reduced or stopped (for example, nitrate derivatives or calcium channel blockers). A reduction in the dosage of any diuretic dosage and finally of the beta blocker may follow, if necessary. Should bradycardia occur, any anti-bradycardia treatments (such as digoxin or amiodarone) must be reduced or stopped before the beta blocker dosage is reduced.
Galinier
Michel
M
Pôle cardiovasculaire et métabolique, CHU de Toulouse, Hôpital Rangueil TSA 50032, F-31509 Toulouse Cedex 9, France. galinier.m@chu-toulouse.fr
Emeriau
Jean-Paul
JP
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male
D000319:Adrenergic beta-Antagonists