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Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Coronary heart disease secondary prevention renin-angiotensin-aldosterone system blockers

Introduction

2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]

2011 AHA/ACCF Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease (DO NOT EDIT) [1]

ACE Inhibitors (DO NOT EDIT) [1]

Class I
“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. [2][3] (Level of Evidence: A)”
Class IIa
“1. It is reasonable to use ACE inhibitors in all other patients. [4] (Level of Evidence: B)

ARBs (DO NOT EDIT) [1]

Class I
“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. [5][6][7] (Level of Evidence: A)”
Class IIa
“1. It is reasonable to use ARBs in other patients who are ACE-inhibitor intolerant. [8] (Level of Evidence: B)
Class IIb
“1. The use of ARBs in combination with an ACE inhibitor is not well established in those with systolic heart failure. [7][9] (Level of Evidence: A)

Aldosterone Blockade (DO NOT EDIT) [1]

Class I
“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 Ξ²-blocker, who have a left ventricular ejection fraction ≀40%, and who have either diabetes or heart failure. [10][11] (Level of Evidence: A)”
β€œ # Estimated creatinine clearance should be >30 mL/min. ”
β€œ ** Potassium should be <5.0 mEq/L. ”
References

References

  1. ↑ 1.0 1.1 1.2 1.3 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. PMIDΒ 22052934.
  2. ↑ Garg R, Yusuf S (1995). “Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials”. JAMA. 273 (18): 1450–6. PMIDΒ 7654275. Unknown parameter |month= ignored (help)
  3. ↑ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000). “Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators”. N. Engl. J. Med. 342 (3): 145–53. doi:10.1056/NEJM200001203420301. PMIDΒ 10639539. Unknown parameter |month= ignored (help)
  4. ↑ Fox KM (2003). “Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)”. Lancet. 362 (9386): 782–8. PMIDΒ 13678872. Unknown parameter |month= ignored (help)
  5. ↑ Pitt B, Poole-Wilson PA, Segal R; et al. (2000). “Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial–the Losartan Heart Failure Survival Study ELITE II”. Lancet. 355 (9215): 1582–7. PMIDΒ 10821361. Unknown parameter |month= ignored (help)
  6. ↑ Pfeffer MA, Swedberg K, Granger CB; et al. (2003). “Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme”. Lancet. 362 (9386): 759–66. PMIDΒ 13678868. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Pfeffer MA, McMurray JJ, Velazquez EJ; et al. (2003). “Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both”. N. Engl. J. Med. 349 (20): 1893–906. doi:10.1056/NEJMoa032292. PMIDΒ 14610160. Unknown parameter |month= ignored (help)
  8. ↑ Yusuf S, Teo K, Anderson C; et al. (2008). “Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial”. Lancet. 372 (9644): 1174–83. doi:10.1016/S0140-6736(08)61242-8. PMIDΒ 18757085. Unknown parameter |month= ignored (help)
  9. ↑ Yusuf S, Teo KK, Pogue J; et al. (2008). “Telmisartan, ramipril, or both in patients at high risk for vascular events”. N. Engl. J. Med. 358 (15): 1547–59. doi:10.1056/NEJMoa0801317. PMIDΒ 18378520. Unknown parameter |month= ignored (help)
  10. ↑ Pitt B, Remme W, Zannad F; et al. (2003). “Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction”. N. Engl. J. Med. 348 (14): 1309–21. doi:10.1056/NEJMoa030207. PMIDΒ 12668699. Unknown parameter |month= ignored (help)
  11. ↑ Zannad F, McMurray JJ, Krum H; et al. (2011). “Eplerenone in patients with systolic heart failure and mild symptoms”. N. Engl. J. Med. 364 (1): 11–21. doi:10.1056/NEJMoa1009492. PMIDΒ 21073363. Unknown parameter |month= ignored (help)


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