Moderate
Bisoprolol × Empagliflozin
Selective beta-adrenergic blockers×Sodium-glucose co-transporter 2 inhibitors (SGLT2i)
Mechanism
Empagliflozin (SGLT2 inhibitor) causes osmotic diuresis and mild hypovolaemia. Combined with a beta-blocker: additive orthostatic hypotension risk, especially in the first weeks.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk. With additional antihypertensives: bradycardia (pulse below 60/min).
Management
The combination is part of guideline-directed therapy in heart failure with reduced ejection fraction and type 2 diabetes. In hypovolaemia (dehydration, vomiting, diarrhoea), temporarily stop empagliflozin. Check blood pressure and creatinine 2 weeks after start.
Sources
- ESC: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– Eur Heart J 2021;42(36):3599–3726