What is the most appropriate drug therapy change for a 70-year-old woman with HFrEF and hypertension currently taking lisinopril and metoprolol tartrate?

The most appropriate change in drug therapy for this patient involves switching from metoprolol tartrate to metoprolol succinate. This change is significant because metoprolol succinate is specifically formulated for the management of heart failure with reduced ejection fraction (HFrEF) and has been shown to provide mortality benefits in this population.

Metoprolol succinate is an extended-release formulation that allows for once-daily dosing and provides more stable plasma drug levels, which is beneficial for heart failure patients who may experience variability in symptoms and medication adherence. In contrast, metoprolol tartrate is an immediate-release formulation that is typically administered twice daily and may not provide the same level of efficacy for heart failure management.

The transition to metoprolol succinate aligns with current guidelines that recommend using an appropriate beta-blocker in the long-term management of HFrEF to improve outcomes, including reducing morbidity and mortality. This adjustment enhances the therapeutic strategy aimed at optimizing heart failure management, particularly in older adults who often present with a more complex clinical picture and may benefit from more stable dosing regimens.

Adopting this change ensures that the patient's treatment is maximized, addressing both her hypertension and her heart failure, and optimizes her prognosis