Renin–angiotensin–aldosterone system inhibitors in the heart failure management

This chapter evaluates the renin–angiotensin–aldosterone system and its inhibitors in the most recent updates of the heart failure (HF) guidelines from various health agencies, which have all been updated in response to therapeutic advancements across the spectrum of left ventricular ejection fraction. There are gaps in knowledge about the role of new therapeutic agents in the management of HF. This review aims to give new information for the care of HF patients based on current data for enhancing treatment quality, emphasizing the role of ACEI/ARB with an evidence-based strategy for managing patients with HF with new suggestions. The guidelines are unanimous in recommending the combination of four standard therapy options for the treatment of HF with reduced ejection fraction (HFrEF). These are angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or angiotensin receptor–neprilysin inhibitors (ARNI); beta-blockers; mineralocorticoid receptor; antagonists; and sodium-glucose cotransporter-2 inhibitor. The Canadian guidelines do, however, recommend that ACEI/ARB be switched to ARNI prior to discharge in patients hospitalized with acutely decompensated HF and that ARNI be started in patients admitted with a new diagnosis of HFrEF. Most guidelines also advise that starting with an ARNI rather than an ACEI/ARB may lead to more rapid optimization of therapy. © 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.