Angiotensin Receptor Blockers (ARBs)

For complete individual drug prescribing information (PI) and updates, please refer to the drug manufacturer or FDA websites.

Initiation

• For patients intolerant to ACEI because of cough or angioedema, or who are already taking ARBs for other reasons, ARBs are a recommended alternative to ACEI (GL).

Titration

• Consider increasing dose of ARB every 2 weeks until maximum tolerated or target dose is achieved (EC).
• For optimal titration of ARBs, lower loop diuretic doses may be necessary to permit titration. In this circumstance, careful attention to potassium concentrations is needed, as the kaluretic effects of loop diuretics may no longer be present, and restriction of supplemental and/or dietary potassium may be necessary (EC).

Monitoring

Within 1-2 weeks after initiation and after dose increase during titration, monitor (EC):

• Blood pressure
• Renal function
• Potassium

ACC/AHA Guideline Recommendations

The use of ARBs to reduce morbidity and mortality is recommended in patients with prior or current symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema (I,A).