Which patient is more likely to benefit from a higher dose of beta-blockers?

The most likely patient to benefit from a higher dose of beta-blockers is one with heart failure and a left ventricular ejection fraction (LVEF) of 25%. In patients with heart failure, particularly those with reduced ejection fraction, beta-blockers have been shown to improve left ventricular function, reduce mortality, and enhance overall quality of life. Higher doses of beta-blockers can lead to significant improvements in outcomes for these patients because they help to counteract the harmful effects of neurohormonal activation seen in heart failure, such as increased heart rate and vasoconstriction.

The need for careful titration and potential use of higher doses is based on the understanding that these patients have more pronounced heart failure symptoms and a greater risk of morbidity and mortality compared to those in other categories. Patients with LVEF lower than 35% are often considered candidates for aggressive beta-blocker treatment in guideline-directed medical therapy for heart failure.

In contrast, other patient categories such as those with NYHA class I heart failure, well-controlled diabetes, or hypertension only, typically do not have the same level of risk or need for aggressive empowerment of beta-blockers, and thus a higher dose may not be as beneficial or necessary for them.