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ARBs serve as a second-line alternative to ACE inhibitors in HFrEF patients who develop a cough or remain symptomatic on optimal therapy, requiring careful monitoring for hypotension, renal dysfunction, and hyperkalemia.
Angiotensin II plays a pivotal role as a compensatory mechanism in heart failure with reduced ejection fraction and in the development of symptoms such as fluid retention. Angiotensin II receptor blockers (ARBs) can be used as an alternative to angiotensin-converting enzyme (ACE) inhibitors in patients in whom a cough develops, as well as for additional therapy in patients who have symptoms that persist despite receiving optimal beta-blockade and ACE inhibition. Although clinical trials of ARBs have not demonstrated superiority over ACE inhibitors they are classified as second-line therapy in this patient population. Similar to ACE inhibitors, common adverse effects include hypotension, renal dysfunction and hyperkalaemia. Nursing care of patients prescribed ARBs involves cardiovascular assessment including volume status, improvement or deterioration in clinical symptoms and biochemical monitoring.
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