Management of Concor and Dapa in DHF with Hypotension

Immediate Assessment and Management

The European Society of Cardiology recommends verifying blood pressure readings in both supine and standing positions to confirm true hypotension and assess for orthostatic changes in patients with DHF 1
Assessing organ perfusion status is crucial, including signs of cardiogenic shock such as altered mental status, cool extremities, oliguria, and elevated lactate, as recommended by the European Society of Cardiology 1, 2
Temporarily reducing the dose or holding bisoprolol is recommended if systolic BP remains <90 mmHg with symptoms or evidence of hypoperfusion, according to the European Society of Cardiology 1, 2

The European Society of Cardiology suggests that beta-blockers should generally not be stopped completely unless the patient is clinically unstable with signs of low cardiac output 3
The American College of Cardiology recommends not permanently discontinuing beta-blockers, planning to restart at a lower dose once BP stabilizes and the acute DHF phase resolves 1, 3

The European Society of Cardiology recommends continuing dapagliflozin as SGLT2 inhibitors have no effect on blood pressure or heart rate 1, 4
The American College of Cardiology suggests that dapagliflozin does not cause symptomatic hypotension and has a favorable safety profile even in vulnerable populations 4, 5

The European Society of Cardiology recommends checking BP hourly along with heart rate, urine output, and mental status in patients with DHF 1, 2
Restarting bisoprolol at a low dose (e.g., 1.25-2.5 mg daily) once BP stabilizes above 100/60 mmHg and DHF enters the recovery phase is recommended by the European Society of Cardiology 1
The European Society of Cardiology suggests continuing dapagliflozin throughout unless acute kidney injury develops with eGFR <20 mL/min/1.73 m² 4