<International Circulation>: You mentioned there the role of beta-receptor blockers and ACE-inhibitors and even though they have proven efficacious in treating heart failure， clinicians cannot standardize the use of these two drugs. What are your views on the appropriate use of beta-blockers and ACE-inhibitors?

    Dr Willenheimer: We have the “start low， go slow” theme which is wise to adhere to and we also have target doses. These target doses are derived from clinical trials looking at the mean effect of treatment in， perhaps， several thousand patients. The individual patient however might have anything from no benefit to a tremendous benefit， much more than the average benefit from the trial， indicating that subjects are very different. For some individuals， maybe a low dose of a beta-blocker is sufficient， whilst in other patients， a much higher dose than the standard target dose is required for a similar outcome. The same might apply to ACE-inhibitors， ARBs and aldosterone antagonists too. Science should be used as a basis， but you always have to individualize therapy based on your clinical skills， and we should never forget that， and always treat any patient as an individual not as an average subject from a clinical trial because no such thing actually exists.

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