The cornerstone of modern medicine in general, therapy and cardiology in particular, is the problem of comorbid pathology. The most common of it is the combination of heart failure which is a frequent and severe complication of many cardiovascular diseases, and obesity, which is rapidly spreading in modern society. The use of beta-blockers, in particular, metoprolol succinate, is one of the most promising pharmacotherapeutic approaches to the treatment of heart failure. However, the question of its effectiveness in the presence of obesity in a patient is not well understood, and the aspect of personification, taking into account the individual characteristics for the pharmacotherapy of a patient is generally open. The purpose of the study was to personify algorithms for using metoprolol succinate in complex pharmacotherapy in patients with chronic heart failure and obesity. Material and methods. In order to personalize the prognostic evaluation of the effectiveness of metoprolol succinate in the complex treatment of patients with heart failure and obesity, we performed a prospective study involving 127 patients of both genders with heart failure of the 2nd–3rd stages aged 32–87 (61 [57; 65]) years, 93 men and 34 women. Results and discussion. The main group consisted of 73 patients with obesity of the 1st degree and above; the comparison group included 54 patients without obesity; there were also 21 practically healthy volunteers. The survey included determination of exercise tolerance, quality of life, central hemodynamics, heart rate variability, serum insulin levels and NT-proBNP, G1846A polymorphism of the CYP2D6*4 gene. Metoprolol succinate was administered according to a standard regimen with the dose titration every 2 weeks with 12.5 mg up to 100–200 mg. We developed a prognostic protocol based on Wald's sequential analysis by means of personifying pharmacotherapy with metoprolol succinate in patients with obesity and heart failure. This protocol can predict the effectiveness of the drug, and discriminant models that allow objectifying the criteria for determining the maximum initial, maximum final dose, and also assess the feasibility of further incremental dose increase. The values of the predictive value indicators in all developed prognostic tools are acceptable for clinical use. The prospect of further research should be in continuation of the dynamic observation of the examined patients with a cross-sectional assessment of the developed means for assessing the effectiveness of metoprolol succinate in the complex treatment of patients with chronic heart failure and obesity.

Keywords: chronic heart failure, obesity, treatment, beta blocker, metoprolol succinate, genetics

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