Ref-Goodman and Gillman 11/e p1336 Clinical use of Beta adrenergic receptor antagonist in hea failure These are now recommended for routine use in class Il or Ill symptoms in conjunction with ACE inhibitoror angiotensin-receptor antagonist, and diuretics These should be initiated at very low doses, generally less than one tenth of the final target dose NYHA Class IIIB and IV patients should be approached with a high level of caution; and in recently decompensated hea failure, beta-blockers should not be used until the patients are stabilizedfor several days to weeks.