New data indicate that beta-blocker tolerability is comparable in heart failure (HF) patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), with relevant heart rate and blood pressure reductions reported in both groups.

Despite broad evidence supporting beta-blocker use in patients with HFrEF, its evidence in HFpEF remains controversial, the researchers wrote.

In the CIBIS-ELD trial, researchers randomly assigned patients aged greater than 65 years who had HFrEF (n=626) or HFpEF (n=250) to either bisoprolol (51% in both groups) or carvedilol (49% in both groups), and up-titrated the drugs to the target or maximum-tolerated dose.


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At 12-week follow-up, tolerability and daily dose for both beta-blockers were similar.

Compared with the HFrEF group, those with HFpEF experienced a higher frequency of delayed up-titration (bisoprolol, P=.001; carvedilol, P=.04) and adverse events (79% vs 58%, respectively; P<.001).

There were no significant between-group differences in mean heart rate change (HFpEF, –6.6 beats/minute vs HFrEF, –6.9 beats/minute), but there was a greater improvement in New York Heart Association class in the HFrEF group (34% vs 23%, respectively; P<.001).

In addition, mean early diastolic mitral annular velocity (E/e’) and left atrial volume index did not significantly differ between groups, whereas the ratio of peak early to late diastolic filling velocity (E/A) was increased in HFpEF patients only (baseline, 0.84 ± 0.32 vs. 12 weeks, 0.91 ± 0.36; P<.001).

“In the majority of elderly patients suffering from HFpEF, an algorithm based up-titration of [beta-blockers] to a given target dose is not feasible,” the researchers wrote. “Our results suggest that [beta-blocker] titration also in HFpEF patients is safe, but that it should be carried out with caution because of adverse events and more delays to reaching the target dose. These results are therefore of importance for the growing proportion of HFpEF patients within the HF population who are already taking [beta-blockers] for the treatment of comorbidities.”

The researchers added that a large, prospective, randomized outcome trial is now urgently needed to define the role of beta-blockers in HFpEF.

Reference

Edelmann F, Musial-Bright L, Gelbrich G, et al. Tolerability and feasibility of beta-blocker titration in HFpEF vs. HFrEF: Insights from the CIBIS-ELD trial. JACC Heart Fail. 2015. doi:10.1016/j.jchf.2015.10.008.