The Living Guidelines: UA/NSTEMI Recommendations for Inhibition of the Renin-Angiotensin-Aldosterone System Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines

 * 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 Receptor Blockade 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)