From the Guidelines
Symphonic doses, also known as therapeutic doses, refer to the use of target doses of multiple medications in combination to achieve the best possible outcomes, as recommended by the American College of Cardiology 1. When it comes to heart failure treatment, symphonic dosing is crucial to optimize treatment outcomes.
- The goal is to achieve target doses of all recommended therapies, including ACE inhibitors, beta-blockers, and diuretics, in the absence of contraindications and/or intolerance 1.
- Titration of these medications should occur even if the patient appears stable or their symptoms and/or ejection fraction improve, as this approach is associated with the best outcomes 1.
- The use of target doses is based on the principle that these doses are associated with improved morbidity, mortality, and quality of life, and should be attempted in all patients 1.
- Regular monitoring of the patient's condition, including blood pressure, heart rate, electrolytes, and renal function, is essential to ensure the safe and effective use of symphonic dosing.
- By using symphonic dosing, healthcare providers can help patients with heart failure achieve better disease control, reduce the risk of complications, and improve their overall quality of life.
From the Research
Definition of Symphonic Doses
Symphonic doses, also known as therapeutic doses, refer to the optimal combination and dosage of medications that work together to achieve a specific therapeutic effect. In the context of hypertension treatment in diabetic patients, symphonic doses involve the use of multiple antihypertensive drugs to control blood pressure and reduce the risk of cardiovascular disease.
Key Considerations for Symphonic Doses
- The choice of antihypertensive agent should be individualized and guided by the presence of concomitant clinical disease and the need to protect any specific target organ system in the diabetic hypertensive 2.
- Most patients require more than one medication to control their blood pressure, and clinicians should follow published guidelines to select the most appropriate and efficacious blood pressure agents for their patients 3.
- The blood pressure goal in diabetic patients should be below 140/90 mmHg, probably down to 130-135/85 mmHg, although the evidence for this is scarce 4.
- Combinations of medications are usually required in diabetic patients because blood pressure control is more difficult to achieve in diabetics than those without diabetes 5.
Examples of Symphonic Doses
- A combination of a renin-angiotensin system blocker and a calcium channel blocker may be a good option for diabetic patients with hypertension 4.
- Diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin-receptor antagonists can all be used to reduce adverse clinical events in diabetic patients with hypertension 2.
- Thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers can be considered as initial therapy for elderly diabetic patients with hypertension 5.