Značaj titracije doze beta blokatora u srčanoj insuficijenciji

Abstract

Heart failure is a clinical syndrome, characterized by the inability of the heart to pump an adequate amount of blood according to the needs of the organs and tissues, at rest and during exertion, despite normal blood flow to the heart. Treatment includes hygienic and dietary measures, pharmacological treatment, installation of an appropriate device, surgical treatment and heart transplantation. Indispensable groups of drugs that reduce mortality in the treatment of this disease are beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors)/angiotensin receptor neprilysin inhibitors (ARNI), mineralocorticoid receptor agonists (MRA), sodium-glucose cotransporter type 2 inhibitors (SGLT inhibitors). By blocking beta receptors and sympathies, beta-blockers relieve the cell, which tried to compensate for the weak function by "accumulating" them. Their gradual introduction is necessary in order to achieve the appropriate effect. Therapy with beta-blockers is started with the lowest dose, which, depending on the clinical condition of the patient, is increased every two weeks until the full dose is reached. The rule of thumb is that a smaller dose is better than none. Thanks to the high selectivity of beta-blockers, they can be used in patients who have comorbidities and heart failure, which is unfortunately a very common case. They can be administered to the patients with chronic obstructive pulmonary disease, diabetes mellitus, peripheral occlusive disease and similar. Beta-blockers, in addition to angiotensinconverting enzyme inhibitors/angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor agonists and sodium-glucose cotransporter type 2 inhibitors, represent the most significant group of drugs that have the greatest impact on disease prognosis, quality of life, morbidity and mortality in patients with heart failure with reduced ejection fraction. Today, they are not used enough because of the fear of developing hypotension and bradycardia, and they are often mistakenly considered contraindicated in the presence of numerous comorbidities.