The short answer from a heart failure expert
A: If you were prescribed an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker or diuretic, your doctor may have explained that the drug needs to be titrated. Titration is a way to limit potential side effects by taking time to see how your body will react to a drug.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
In titration, the medication is started at a low dose. Every couple of weeks, the dose is raised (“up-titrated”) until the maximum effective dose (“target dose”) has been achieved or side effects occur.
Not everyone can tolerate a full dose. It’s safer to ease your way up.
The drugs mentioned above lower blood pressure and heart rate by blocking neurohormonal and adrenaline pathways. These are innate mechanisms designed to safeguard humans — and the reason why titration is essential.
You need adrenaline to run away from a bear, but your adrenaline level has to come down after the bear is gone. If you block adrenaline completely, the bear will catch you, so we block some of the adrenaline slowly and gradually. This allows you to react to the bear, while giving your heart time to get better and stronger between bear attacks. The next time we increase the dose, the heart tolerates it better.
Ideally, patients should aim for the target dose of these medications. Unfortunately, titration is sometimes overlooked.
We see patients who have been on a low dose for months. They are on the right drug, but their heart isn’t getting better, because the drug was never up-titrated. Some people don’t need as much of the drug as others, but we don’t know who they are until we discover the highest dose they can tolerate.
— Heart failure specialist David Taylor, MD
This article was adapted from Cleveland Clinic Heart Advisor.
Learn more about our editorial process.
First things first — slowly sit or lie down
Absolutely! In fact, in many ways, exercise is key to recovery
There’s no way to stop it once a heart attack is happening, but the most important thing you can do is to call for help
You can counter the risk of prediabetes-related heart attack or stroke by eating more fruits, vegetables and whole grains, as well as exercising regularly
An ideal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic
Age, sex and genetics are just a few factors that can affect your risk of developing coronary heart disease
LDL cholesterol and lipoprotein (a) cholesterol are more likely to stick to your arteries and lead to dangerous heart events
Having underweight, having overweight and having obesity can be dangerous for your heart
Your metabolism may torch 1,300 to 2,000 calories daily with no activity
A gentle touch in all the right places may help drain your sinuses