Treatment of Older Patients With CHF Associated With Normal LVEF.
CHF with a normal LVEF should be treated with a low salt diet, cautious use of loop diuretics, and Ã -blockers. If CHF persists despite the use of diuretics and Ã -blockers, ACE inhibitors should be administered. If the patient cannot tolerate ACE inhibitors because of cough, rash, or altered taste sensation, angiotensin II type 1 receptor antagonists should be given. If CHF persists despite treatment with diuretics, Ã -blockers, and ACE inhibitors, isosorbide dinitrate plus hydralazine should be given. If the patient cannot tolerate Ã -blockers, ACE inhibitors, and angiotensin II type 1 receptor antagonists, isosorbide dinitrate plus hydralazine should be administered. If CHF persists despite the use of diuretics and the patient is unable to tolerate Ã -blockers, ACE inhibitors, and isosorbide dinitrate plus hydralazine, calcium channel blockers are preferred. Digoxin should be avoided if sinus rhythm is present.
Aronow
Wilbert S.
WS
Hebrew Hospital Home, Bronx, NY and the Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York.