ARBs

Key Points 

  • Angiotensin receptor blockers or ARBs are recommended in patients with heart failure with reduced ejection fraction (LVEF <40%) who are intolerant of ACE inhibitors due to cough 
  • ARBs have been shown in clinical trials to decrease the combined endpoint of cardiovascular mortality and hospitalization for heart failure
  • ARB should be considered  in patients with a mild reduction in ejection fraction (LVEF 41–49%) , if an ACE inhibitor is contraindicated or not tolerated
  • Assess blood pressure, renal function, and serum potassium within 1 to 2 weeks after starting an ARB
  • Angioedema is a rare but serious adverse effect of ACE inhibitors but some patients may also react to ARBs-particularly in people of African decent 
  • The recommended ARBs for heart failure therapy are candasartan, losartan, and valsartan

Using STEPPED CARE for ARBs

Candasartan

  • Initial dose: 4 mg PO QD
  • Step one: 8 mg PO QD
  • Step two: 16 mg PO QD
  • Step three: 32 mg PO QD

Valsartan

  • Initial dose: 20 mg PO BID
  • Step one: 40 mg PO BID
  • Step two: 80 mg PO BID
  • Step three: 160 mg PO BID

Losartan

  • Initial dose: 25 mg PO QD
  • Step one: 50 mg PO QD
  • Step two: 100 mg PO QD
  • Step three: 150 mg PO QD