A vantage point or real added value? Is the classical uptitration strategy of the ß-blockers still relevant?
Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet, Kardiológiai Osztály, Szolnok
Since decades, the usage of ß-blockers represents the cornerstone in the therapy of heart failure. The time that has passed made the completion of several mega-trials possible, and the clarification in recommendations based upon these studies. The explosion like appearance of ivabradine represented a quality leap and brought new and fundamental changes in clinical treatments. But unfortunately, the creation of new guidelines is indeed a process with considerable inertia, and the time lost during this process does not serve the interest of the patient. We should never disregard professor Ferrari’s opinion with regard to the „diamond” approach in the treatment of angina, which represents radical change in attitude and goes beyond our presently accepted protocols. Among the new opportunities – the ivabradine-carvedilol combination therapy – has its very unique place. The author gives detailed coverage of the unprecedented advantages of this combination therapy, supported with an overview of clinical observations and with argumentative pharmacodynamical reasoning, expressed also in many other authors calling for a renewed therapeutic strategy.