All are true about staing of b-Blocker therapy in a case of CHF except-
Ref : Davidsons Principles and practice of medicine_22Ed pg no:552 Beta-adrenoceptor blocker therapy Beta-blockade helps to counteract the deleterious effects of enhanced sympathetic stimulation and reduces the risk of arrhythmias and sudden death. When initiated in standard doses, they may precipitate acute-on-chronic hea failure, but when given in small incremental doses (e.g. bisoprolol staed at a dose of 1.25 mg daily, and increased gradually over a 12-week period to a target maintenance dose of 10 mg daily), they can increase ejection fraction, improve symptoms, reduce the frequency of hospitalisation and reduce moality in patients with chronic hea failure (Box 18.19). Betablockers are more effective at reducing moality than ACE inhibitors: relative risk reduction of 33% versus 20%, respectively.
They should be staed with optimal doses
They should be gradually increased over weeks
Special precautions should be takenin casesof NYHA class III and IV
Carvedilol and Metoprolol are the preferred drugs
C.V.S