Reaching betablockers target dose in elderly patients with chronic heart failure

Despite overwhelming evidence of clinical efficacy, the use and dose of betablockers in elderly patients with chronic heart failure are often suboptimal. The underuse and underdose of betablockers in elderly may reflect true intolerability in older patients with comorbidities and with increased risk of side effects. Different betablockers may have different side-effects because of different pharmacological properties. Difference between betablockers use in the clinical practice and clinical trials might be explained by the fact that the major large-scale betablockers trials enrolled younger patients. The highest tolerability in elderly heart failure patients was reported for nebivolol. The tolerability of nebivolol in older patients might be explained by its unique pharmacological properties.