Cardiology and Angiology: An International Journal

Beta-blocker therapy remains a cornerstone of heart failure (HF) management, but its role in Asian populations is shaped by unique pharmacogenomic and economic factors. Registry data show prescription rates ranging from 61% in Indonesia to 91% in Japan, with consistently favorable outcomes despite markedly lower achieved doses compared to Western cohorts. Japanese patients, for example, attain equivalent survival and functional benefits at one-third of U.S. target doses, underscoring the need for region-specific dosing strategies. Across HF phenotypes, beta-blockers reduce mortality and hospitalization with no significant differences in adverse event rates among agents, and lower discontinuation rates in Asian cohorts suggest superior tolerability. Combination therapy with SGLT2 inhibitors, such as dapagliflozin, yields additive benefits, as efficacy persists regardless of background beta-blocker use. These findings support individualized therapy in Asia, highlighting the importance of integrating pharmacogenomics, health system capacity, and comorbidities into clinical decision-making.