Increased angina during β-blocker w/drawal. Taper β-blocker dose before treatment initiation. Possible severe hypotension & cardiac output lowering in patients w/ severe heart failure. Patients w/ heart failure; severe aortic stenosis. Increased CV complications (eg, MI) & mortality; only use for patients w/ essential HTN & chronic angina pectoris if other drugs are not indicated. Monitor BP & heart rate carefully during therapy. Closely observe patients concomitantly taking BP-lowering medications. Potential mild to moderate peripheral edema typically associated w/ arterial vasodilation; differentiate this peripheral edema from the effects of increasing left ventricular dysfunction in patients w/ CHF-complicated angina. May require adjustment in diabetic patients. Elderly (especially to those w/ history of hypotension or cerebral vascular insufficiency).
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