A 69-year-old man with recently diagnosed heart failure with reduced ejection fraction (LVEF 32%) has been started on Ramipril 2.5 mg, titrated to 10 ...

Question

A 69-year-old man with recently diagnosed heart failure with reduced ejection fraction (LVEF 32%) has been started on Ramipril 2.5 mg, titrated to 10 mg over 4 weeks. He also starts Bisoprolol 1.25 mg. His resting heart rate is 78 bpm and blood pressure is 112/68 mmHg. He feels tired. What is the MOST appropriate next step regarding his Bisoprolol?

Accepted Answer

Gradually uptitrate Bisoprolol to the maximum tolerated dose (target 10 mg daily), guided by heart rate and blood pressure

Answer

Stop Bisoprolol as his blood pressure is low

Answer

Continue Bisoprolol at 1.25 mg indefinitely

Answer

Switch to Verapamil for better rate control

Answer

Add Ivabradine instead of uptitrating Bisoprolol

uk-dgm MCQ (SBA): Beta-Blocker Uptitration in HFrEF