Initially, when I read the case, my first intention was to add an aldosterone antagonist to the patient’s blood pressure regimen, as well. However, according to the ACCF/AHA Guideline for the Management of Heart Failure, aldosterone receptor antagonists are recommended only in patients who have an LVEF of 35% or less (level of evidence A) and in patients after an acute MI (less than 40 days) with an LVEF of 40% or less with HF symptoms (level of evidence B). Apparently, aldosterone receptor antagonists can be harmful because of life-threatening hyperkalemia.
Then I contemplated to switch to a loop diuretic, but they are not recommended unless the patient has an EF<40, a CrCl of less than 30 mL, or the patient’s BP level is becoming resistant
Then I contemplated to switch to a loop diuretic, but they are not recommended unless the patient has an EF<40, a CrCl of less than 30 mL, or the patient’s BP level is becoming resistant