lightheadedness, or blurred vision79. These vasodilatory side effects are generally seen within 24 to 48 hours of the first dose or the first increments in dose and usually subside with repeated dosing without any change in dose. Physicians may minimize the risk of hypotension by administering the betablocker and ACE inhibitor at different times during the day. If this is ineffective, the occurrence of hypotension may require a temporary reduction in the dose of the ACE inhibitor. Hypotensive symptoms may also resolve after a decrease in the dose of diuretics in patients who are volume depleted, but in the absence of such depletion, relaxation of diuretic therapy may increase the risk or consequences of fluid retention.
A list of inhibitors of the renin-angiotensin-aldosterone system and beta-blockers that are commonly used for the treatment of patients with HF with low EF is presented below:
79 Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 1996;334:1349-55.