BB remains foundational therapy for heart failure with reduced ejection fraction (HFrEF), but concerns regarding early intolerance often limit dose escalation. In a retrospective study published in Frontiers in Cardiovascular Medicine, tolerance to initial high-dose BB therapy was evaluated in patients with HFrEF and hypertension.

The analysis included 307 hospitalized adults with HFrEF who initiated BB therapy during admission. Patients were categorized based on initial BB dose. A high-dose strategy was defined as an initial dose exceeding one-eighth of the guideline-recommended target dose, while all other patients were assigned to the standard-dose group. Demographic and clinical variables were obtained from electronic medical records (EMR). Multivariable logistic forward regression was used to assess factors associated with high-dose initiation and in-hospital safety outcomes.

Seventy patients (22.8%) received an initial high BB dose. Coronary heart disease was inversely associated with high-dose initiation, with an odds ratio (OR) of 0.435 (95% confidence interval (CI), 0.247–0.763; P = 0.004). Initial high-dose BB therapy showed no independent association with bradycardia, hypotension, acute HF, wheezing requiring bronchodilator therapy, or BB dose reduction or discontinuation during hospitalization.

These findings indicate that initial high-dose BB therapy was not linked to excess short-term safety events in patients with HFrEF and hypertension. This approach may be feasible during inpatient initiation.