Page 241 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 13 Drugs Used in Heart Failure 227

Vardeny O, Tacheny T, Solomon SD: First in class angiotensin receptor neprilysin Guidelines and the Heart Failure Society of America. J Am Coll Cardiol
inhibitor in heart failure. Clin Pharmacol Ther 2013:94:445. 2016;68:1476.
Yancy CW et al: 2016 ACC/AHA/HFSA focused update on new pharmacologi- Yancy CW et al: 2013 ACCF/AHA guidelines for the management of heart
cal therapy for heart failure: An update of the 2013 ACCF/AHA Guideline failure: A report of the American College of Cardiology Foundation/
for the Management of Heart Failure: A report of the American College American Heart Association Task Force on Practice Guidelines. Circulation
of Cardiology/American Heart Association Task Force on Clinical Practice 2013;128:1810.

C ASE STUD Y ANSWER

The patient has a low ejection fraction with systolic heart continued shortness of breath on exercise, digoxin at
failure, probably secondary to hypertension. His heart fail- 0.25 mg/d was added with a further modest improvement
ure must be treated first, followed by careful control of the in exercise tolerance. The blood pressure stabilized at
hypertension. He was initially treated with a diuretic (furo- 150/90 mm Hg, and the patient will be educated regarding
semide, 40 mg twice daily). On this therapy, he was less the relation between his hypertension and heart failure
short of breath on exertion and could also lie flat without and the need for better blood pressure control. Cautious
dyspnea. An angiotensin-converting enzyme (ACE) inhib- addition of a β blocker (metoprolol) will be considered.
itor was added (enalapril, 20 mg twice daily), and over Blood lipids, which are currently in the normal range, will
the next few weeks, he continued to feel better. Because of be monitored.