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 à -blockers. If CHF persists despite the use of diuretics and à -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, à -blockers, and ACE inhibitors, isosorbide dinitrate plus hydralazine should be given. If the patient cannot tolerate à -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 à -blockers, ACE inhibitors, and isosorbide dinitrate plus hydralazine, calcium channel blockers are preferred. Digoxin should be avoided if sinus rhythm is present.