Coronary heart disease secondary prevention renin-angiotensin-aldosterone system blockers
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Renin-angiotensin-aldosterone system blockers
ACC / AHA 2011 Guidelines - Coronary Heart Disease - Secondary Prevention with Renin-angiotensin-aldosterone system blockers (DO NOT EDIT) [1]
ACE Inhibitors
| Class I |
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"1. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction ≤40% and in those with hypertension, diabetes, or chronic kidney disease, unless contraindicated. (Level A)" |
| Class IIa |
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"1. It is reasonable to use ACE inhibitors in all other patients. (Level B) |
ARBs
| Class I |
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"1. The use of ARBs is recommended in patients who have heart failure or who have had a myocardial infarction with left ventricular ejection fraction ≤40% and who are ACE-inhibitor intolerant. (Level A)" |
| Class IIa |
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"1. It is reasonable to use ARBs in other patients who are ACE-inhibitor intolerant. (Level B) |
| Class IIb |
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"1. The use of ARBs in combination with an ACE inhibitor is not well established in those with systolic heart failure (Level A) |
Aldosterone blockade
| Class I |
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"1. Use of aldosterone blockade in post–myocardial infarction patients without significant renal dysfunction or hyperkalemia is recommended in patients who are already receiving therapeutic doses of an ACE inhibitor and β-blocker, who have a left ventricular ejection fraction ≤40%, and who have either diabetes or heart failure (Level A)" |
References
- ↑ Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA; et al. (2011). "AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation". Circulation. 124 (22): 2458–73. doi:10.1161/CIR.0b013e318235eb4d. PMID 22052934.