Congestive heart failure angiotensin receptor blockers

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ACC/AHA Guideline Recommendations

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Congestive heart failure end-of-life considerations

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Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [2] and C. Michael Gibson, M.S., M.D. [3], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [4] Edzel Lorraine Co, DMD, MD[5]

Synonyms and Keywords: Angiotensin II receptor antagonist, Angiotensin receptor blocker

Angitensin II Receptor Antagonist Use

Indications for Angiotensin II Receptor Antagonist Use

1. The left ventricular ejection fraction (LVEF) is ≤ 40%

or

2. There is a prior history of myocardial infarction (MI)

Background

Dosing

  • ACE-I or ARB therapy should be initiated at low dosage

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [3]

Renin-Angiotensin System Inhibition With ACEi or ARB or ARNi

Class I
"1. In patients with HFrEF and NYHA class II to III symptoms, the use of ARNi is recommended to reduce morbidity and mortality. [4][5][6][7][8](Level of Evidence: A) "
"2. In patients with previous or current symptoms of chronic HFrEF, the use of ACEi is beneficial to reduce morbidity and mortality when the use of ARNi is not feasible.[9][10][11][12][13][14][15][16] (Level of Evidence: A) "
"3. In patients with previous or current symptoms of chronic HFrEF who are intolerant to ACEi because of cough or angioedema and when the use of ARNi is not feasible, the use of ARB is recommended to reduce morbidity and mortality. [17][18][19][20][21] (Level of Evidence: A) "
"5. In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACEi or ARB, replacement by an ARNi is recommended to further reduce morbidity and mortality. [4][5][6][7][8](Level of Evidence: B-R) "
Class Value Statement: High Value
"4. In patients with previous or current symptoms of chronic HFrEF, in whom ARNi is not feasible, treatment with an ACEi or ARB provides high economic value. [22][23][24][25][26][27][28](Level of Evidence: A) "
"6. In patients with chronic symptomatic HFrEF, treatment with an ARNi instead of an ACEi provides high economic value. [29][30][31][32] (Level of Evidence: A) "
Class III (Harm)
"7. ARNi should not be administered concomitantly with ACEi or within 36 hours of the last dose of an ACEi. [33][34] (Level of Evidence: B-R) "
"8. ARNi should not be administered to patients with any history of angioedema.[35][36][37][38] (Level of Evidence: C-LD) "
"9. ACEi should not be administered to patients with any history of angioedema. [39][40][41][42] (Level of Evidence: C-LD) "

Related Chapters

Sources

References

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