Moderate
Bisoprolol × Spironolactone
Selective beta-adrenergic blockers×Potassium-sparing diuretics (mineralocorticoid receptor antagonists)
Mechanism
Standard combination in heart failure with reduced ejection fraction – additive antihypertensive effect. Spironolactone retains potassium, reducing arrhythmia risk on a beta-blocker.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
Standard combination. Check potassium and creatinine 1 week after start, then monthly. If potassium exceeds 5.5 mmol/L, reduce spironolactone.
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