Abstract
Contemporary evidence challenges established paradigms surrounding beta-blocker therapy in heart failure management, particularly among Asian populations. The accumulated data demonstrates that beta-blockers exhibit
remarkable therapeutic efficacy across diverse heart failure phenotypes when dosing strategies account for population-specific pharmacokinetic properties. Regional prescription disparities—ranging from 61% adoption in Indonesia to 91% in Japan—belie the consistent mortality benefits observed throughout Asian cohorts. The
pharmacogenetic distinctions between Asian and Western populations warrant substantive reconsideration of dosing protocols. Japanese patients achieve equivalent clinical outcomes at reduced doses compared to their Western
counterparts, necessitating a departure from universal dosing standards. Safety profiles among Asian populations further support tailored therapeutic approaches. The reduced discontinuation rates and favorable adverse event profiles observed in Asian cohorts suggest that concerns regarding beta-blocker tolerability may be less pronounced when dosing strategies reflect population-specific characteristics. The compatibility between beta-blockers and contemporary heart failure therapeutics, particularly SGLT2
inhibitors, presents opportunities for synergistic treatment approaches. Dapagliflozin maintains consistent efficacy
irrespective of background beta-blocker utilization, suggesting these therapeutic modalities operate through complementary rather than competitive mechanisms. Guideline discordance between major cardiology organizations reflects the evolving understanding of heart failure therapeutics, particularly in HFpEF management. Cardioselective beta-blockers demonstrate promise in Asian populations, especially when prescribed considerations account for comorbid conditions and left ventricular function. Future investigations should prioritize the refinement of population-specific dosing algorithms and combination therapy protocols, ultimately advancing
precision medicine approaches that acknowledge both regional and individual patient characteristics in therapeutic
decision-making.
