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Cardio Diabetes Medicine 2017 461

risk of hypotension and renal insufficiency and may symptomatic patients with HFrEF, despite treatment
lead to angioedema, as well. Ivabradine can be with an ACEI and, in most cases, a diuretic, but have
beneficial to reduce HF hospitalization for patients not been tested in congested or decompensated
with symptomatic (NYHA class II-III) stable chronic patients. There is consensus
HFrEF (LVEF ≤35%) who are receiving GDEM, including that beta-blockers and ACEIs are complementary,
a beta blocker at maximum tolerated dose, and who and can be started together as soon as the diagnosis
are in sinus rhythm with a heart rate of 70 bpm or of HFrEF is made. There is no evidence favouring
greater at rest.( ACC/AHA class IIa).
the initiation of treatment with a beta-blocker before
an ACEI has been started. Betablockers should be
Beta-blockers initiated in clinically stable patients at a low dose and
Beta-blockers reduce mortality and morbidity in
Cardio Diabetes Medicine