Characteristics associated with upper-range doses of beta-blockers and angiotensin-renin inhibitors in reduced ejection fraction

Osnat Itzhaki Ben Zadok*, Daniel Murninkas, Zaza Lakobishvili, Henri Jino, Esther Yohananov, Shlomo Birkenfeld, David Hasdai

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-ls), angio-tensin receptor blockers (ARBs), and beta blockers (BBs). Objectives: To determine factors associated with attaining up-per-range doses in patients with HFrEF. Methods: We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines. Results: The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titra-tion program, 41% and 35% of patients achieved upper-range doses of ACE-ls/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-l/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P= 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI S 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P= 0.031). Conclusions: Achieving upper-range doses of ACE-ls/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.

Original languageEnglish
Pages (from-to)375-379
Number of pages5
JournalIsrael Medical Association Journal
Issue number7
StatePublished - Jul 2020


  • Heart failure
  • Reduced ejection fraction (HFrEF)
  • Systolic dysfunction


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