Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for inhibitors of the RAS


 * Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

==ACC / AHA Guidelines - Inhibition Of The Renin-Angiotensin-Aldosterone System(DO NOT EDIT) ==

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Class I
1. Angiotensin-converting enzyme inhibitors should be given and continued indefinitely for patients recovering from UA / NSTEMI with HF, LV dysfunction (LVEF <40%), hypertension, or diabetes mellitus, unless contraindicated. (Level of Evidence: A)

2. An angiotensin receptor blocker should be prescribed at discharge to those UA/ NSTEMI patients who are intolerant of an ACE inhibitor and who have either clinical or radiological signs of HF and LVEF <40%. (Level of Evidence: A)

3. Long term Aldosterone antagonist should be prescribed for UA / NSTEMI patients without significant renal dysfunction (estimated creatinine clearance should be >30 mL/min) or hyperkalemia (potassium should be ≤5 mEq/liter) who are already receiving therapeutic doses of an ACE inhibitor, have an LVEF ≤40%, and have either symptomatic heart failure or diabetes mellitus. (Level of Evidence: A)

Class IIa
1. Angiotensin-converting enzyme inhibitors are reasonable for patients recovering from UA / NSTEMI in the absence of LV dysfunction, hypertension, or diabetes mellitus unless contraindicated. (Level of Evidence: A)

2. Angiotensin-converting enzyme inhibitors are reasonable for patients with HFand LVEF >40%. (Level of Evidence: A)

3. In UA / NSTEMI patients who do not tolerate ACE inhibitors, anangiotensin receptor blocker can be useful as an alternative to ACE inhibitors in long term management provided there are either clinical or radiological signs of HF andLVEF <40%. (Level of Evidence: B)

Class IIb
1. The combination of an ACE inhibitor and an angiotensin receptor blocker may be considered in the long-term management of patients recovering from UA / NSTEMI with persistent symptomatic HF and LVEF <40% despite conventional therapy including anACE inhibitor or an angiotensin receptor blocker alone. (Level of Evidence: B)}}