A 64-year-old man with diet-controlled type 2 diabetes mellitus, ischemic cardiomyopathy, and systolic heart failure comes to the physician for follow-up. The patient has New York Heart Association functional class II symptoms and shows no signs of fluid overload. His daily medications include furosemide, carvedilol, lisinopril, atorvastatin, and low-dose aspirin.
The patient's blood pressure is 155/90 mm Hg and pulse is 60/min.
His potassium level is 4.2 mEq/L and serum creatinine level is 0.9 mg/dL.
Adding losartan to this patient's current regimen is most likely to result in which of the following?

Question

A 64-year-old man with diet-controlled type 2 diabetes mellitus, ischemic cardiomyopathy, and systolic heart failure comes to the physician for follow-up.  The patient has New York Heart Association functional class II symptoms and shows no signs of fluid overload.  His daily medications include furosemide, carvedilol, lisinopril, atorvastatin, and low-dose aspirin.
The patient's blood pressure is 155/90 mm Hg and pulse is 60/min.
His potassium level is 4.2 mEq/L and serum creatinine level is 0.9 mg/dL.
Adding losartan to this patient's current regimen is most likely to result in which of the following?

Quizplus · Accepted Answer

Blockade of the renin-angiotensin system with ACE inhibitors or angiotensin receptor blockers (ARBs) significantly improves cardiovascular outcomes and overall mortality in patients with congestive heart failure due to left ventricular systolic dysfunction. However, dual blockade with both ACE inhibitors and ARBs has not been shown to provide any significant improvement in cardiovascular or all-cause mortality compared to monotherapy alone (Choice C). In addition, dual therapy is associated with an increased risk for hyperkalemia (Choice E), symptomatic hypotension, and worsening renal function and therefore is not recommended. In contrast, the addition of an aldosterone antagonist to existing beta-blocker and ACE inhibitor therapy is recommended in certain patients with heart failure. certain patients (Choice A) While not improving mortality or total hospitalizations, dual blockade of the renin-angiotensin system with ACE inhibitors and ARBs is associated with a reduction in the risk of heart failure-associated hospital admission. (Choice D) Dual therapy is not associated with any significant change in the risk of arrhythmia compared to monotherapy alone. Educational objective: Dual blockade of the renin-angiotensin system with both ACE inhibitors and ARBs does not provide any significant benefit to cardiovascular or all-cause mortality over ACE inhibitors alone. Dual therapy is associated with an increased risk for hyperkalemia, hypotension, and worsening renal function. __________ References: Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials. (http://www.ncbi.nlm.nih.gov/pubmed/23358488) Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: a quantitative review of data from randomized clinical trials. (http://www.ncbi.nlm.nih.gov/pubmed/17923591)

A 64-Year-Old Man with Diet-Controlled Type 2 Diabetes Mellitus, Ischemic