Initial high-dose β-blockers toleration with reduced ejection fraction heart failure of hospitalized hypertensive patients

Background β -blockers (BB) are the cornerstone of treatment for heart failure with reduced ejection fraction (HFrEF). However, due to potential adverse effects, guidelines recommend starting with a low dose and gradually titrating upwards. Hypertensive patients with HFrEF tend to have better drug responsiveness and prognosis, but it remains unclear whether they can tolerate initial high-dose BB. Therefore, this study aims to assess the tolerance of this population to initial high-dose BB therapy. Methods A retrospective observational study included 307 hypertensive patients with HFrEF who initiated BB therapy and were admitted to the cardiology department at West China Hospital, Sichuan University. Patients’ demographic and clinical information was collected through the electronic medical record (EMR) system. Patients were categorized into a high-dose group if their initial BB dose exceeded 1/8 of the target dose, all other patients were assigned to the standard-dose group. Multivariate logistic forward regression analysis was performed to explore factors influencing the prescriptions of intial high-dose BB and adverse safety outcomes related to BB therapy during hospitalization, including bradycardia, hypotension, acute HF, wheezing requiring bronchodilator therapy, and BB dose reduction or cessation. Results Seventy patients (22.8%) were initially prescribed high-dose BB. Logistic forward regression analysis revealed that only coronary heart disease was negatively associated with the prescriptions of initial high-dose BB, with an odds ratio of 0.435 (95% CI: 0.247–0.763, P = 0.004). Further logistic regression analysis demonstrated no independent association between the initial high-dose BB therapy and the occurrence of adverse safety outcomes, including bradycardia, hypotension, acute HF, wheezing requiring bronchodilator therapy, or BB dose reduction or discontinuation (all p < 0.05). Conclusion Prescriptions of initial high-dose BB in hypertensive patients with HFrEF were not associated with an increased incidence of adverse safety outcomes. These findings indicate that initial high-dose BB therapy could be a viable strategy for this population.