Use of a beta-blocker in patients with preserved ejection fraction heart failure (HFpEF) and hypertension is reasonable to control blood pressure.Ī target dose of 100 to 200 mg/day PO has been studied. The use of an evidence-based beta blocker is recommended for patients with HFrEF NHYA class I to IV. Guidelines recommend an evidence-based beta blocker in combination with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) and aldosterone antagonist, in select patients, for patients with chronic reduced ejection fraction heart failure (HFrEF) to reduce morbidity and mortality. If patients experience symptomatic bradycardia, reduce the metoprolol dose. ![]() Initial difficulty with titration should not preclude later attempts to introduce therapy. Do not increase the dose until symptoms of worsening heart failure have been stabilized. If transient worsening of heart failure occurs, consider treating with increased doses of diuretics or lowering the dose or temporarily discontinuing metoprolol. Double the dose every 2 weeks as tolerated, up to the target dosage of 200 mg PO once daily. ![]() ![]() Initially, 25 mg PO once daily in patients with NYHA class II heart failure or 12.5 mg PO once daily in patients with more severe heart failure.
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