Achievement of optimum heart rate should be the priority...as to the goal of beta blocker dosage...it should be as much as can be tolerated by an individual patient....and this is bound to vary from patient to patient.

The target dose of b-blocker should be originally adjusted for each patient with systolic chronic HF considering the presence of comorbidities and hemodynamic parameters. 

 Meta-analysis of HR reduction and improvement in survival in patients with chronic HF indicates that HR reduction is more important than the titrated dose of β-blockers, although the relative importance of HR reduction in improvement of prognosis is not clear. A recent study in which ivabradine decreased the hospitalization from HR deterioration in patients with chronic HF, demonstrated that further HR reduction with optimal treatment for HF is beneficial for clinical outcomes.

Thanks a lot for your answer.

I am completely agree that HR more important then doses of BB.

But I have another question - why some time we do not give to the patients full doses of BB despite HR more than 60 BPM and acceptable BP?

Dear Tatiyana,

pleas see my answer about ivabradin in another question...

https://www.researchgate.net/post/Chronic_heart_failure_and_target_doses_of_beta-blocker_and_ACE_inhibitors

If we talk about Ivabradin In my opinion this medications often prescribe under recommendations. Maybe due to pharma promotional or another reason.

Ivabradine only indicated to reduce the risk of hospitalization for worsening heart failure in patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction ≤35 %, who are in sinus rhythm with resting heart rate ≥70 beats per minute and either are on maximally tolerated doses of beta blockers or have a contraindication to beta blocker use.

Heart Rate or Beta-Blocker Dose? Association With Outcomes in Ambulatory Heart Failure Patients With Systolic Dysfunction: Results From the HF-ACTION Trial.

There were more associated improvements in outcomes with higher BB dose than with reduced HR in this well-treated HF cohort with systolic dysfunction, which suggests that titration of BB doses may confer a greater benefit than reduction of HR in such patients.

Article Heart Rate or Beta-Blocker Dose? Association With Outcomes i...

Selection of a suitable beta-blocker according to the individual sensitivity of the patient. If the heart rate is slowed down too much by too low doses the beta-blocker should be changed.

What BB you usually pref?

I am a veterinarian. Animals are very sensitive to beta-blockers. Choices are based on heart rate, heart rhythm, blood sugar levels, liver disease, kidney disease, etc. The choice is strictly individual, so I will point out some of the most commonly used carvedilol, bisoprolol, atenolol, metoprolol...

Error! One of the indicated beta blockers is not suitable for heart failure.

I think its the heart rate.....we can increase the dose of beta blocker to the maximum tolerable limit in chronic heart failure, but the heart rate control is very essential and to be done meticulously to keep an overall optimal control.

Dear Atanas!

Your message: One of the indicated beta blockers is not suitable for heart failure.

What kind?

Sorry! For systolic heart failure.

Thank you. Mistake corrected.

Сердечный ритм