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Are Patients at Risk for Angioedema When Switching Heart Failure Meds?

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  1. You are a member of the healthcare team seeing a 60-year-old woman with a history of type 2 diabetes with nephropathy and hypertension. What should you consider as you weigh treatment with angiotensin-converting enzyme inhibitors (ACEis) vs angiotensin receptor blockers (ARBs)?
    Up to 1% of patients receiving ACEis develop angioedema
    Increases in serum histamine are responsible for angioedema associated with ACEis and ARBs
    Rates of angioedema are similar with ACEis and ARBs
    ARBs are associated with higher rates of angioedema vs ACEis
  2. The patient initiates treatment with an ACEi, but 2 years later she develops heart failure with reduced ejection fraction (HFrEF). What should you consider regarding the results of the current study by Eworuke as you consider her management?
    The risk for angioedema was similar in the ACEi, ARB, and angiotensin receptor neprilysin inhibitor (ARNI) cohorts
    Switching from an ACEi to an ARNI was protective against angioedema
    Switching from an ARB to an ARNI was protective against angioedema
    The ARNI was associated with higher rates of angioedema vs ARBs