When are ARBs considered for patients with HFpEF?

Angiotensin Receptor Blockers (ARBs) are specifically considered for patients with Heart Failure with Preserved Ejection Fraction (HFpEF) primarily when they meet the criteria for ACE inhibitors but are intolerant to them. This approach is grounded in the similar pharmacological effects of both ACE inhibitors and ARBs. Both classes of medication help to mitigate the neurohormonal activation that contributes to heart failure symptoms and progression.

Patients who are candidates for ACE inhibitors generally have a compelling indication for treatment due to their ability to reduce morbidity and mortality in heart failure. However, if a patient experiences side effects or unacceptable reactions to ACE inhibitors, ARBs can be a suitable alternative. They provide a similar mechanism of action by blocking the effects of angiotensin II, without some of the common side effects associated with ACE inhibitors, such as a persistent cough or angioedema.

Utilizing ARBs in this manner ensures that patients who cannot tolerate ACE inhibitors still receive the benefits of treatment aimed at managing their heart failure and improving their overall outcomes. Thus, this approach aligns with best practices in managing HFpEF and optimally addresses the needs of patients facing intolerance to ACE inhibitors.