32
Treatment
7.3.8. GDMT Dosing: Sequencing and Uptitration
COR LOE
Recommendations
1 A 1. In patients with HFrEF, titration of guideline-directed
medication dosing to achieve target doses showed to be
efficacious in RCTs is recommended, to reduce cardiovascular
mortality and HF hospitalizations, unless not well tolerate.
2a C-EO 2. In patients with HFrEF, titration and optimization of
guideline-directed medications as frequently as every 1 to 2
weeks depending on the patient's symptoms, vital signs, and
laboratory findings can be useful to optimize management.
Table 14. Drugs Commonly Used for HFrEF (Stage C HF)
Drug
Initial Daily
Dose(s) Target Doses(s)
Mean Doses
Achieved in
Clinical Trials
ACEi
Captopril 6.25 mg 3 times
daily
50 mg 3 times daily 122.7 mg total daily
Enalapril 2.5 mg twice daily 10–20 mg twice
daily
16.6 mg total daily
Fosinopril 5–10 mg once daily 40 mg once daily NA
Lisinopril 2.5–5 mg once
daily
20–40 mg once
daily
32.5–35.0 mg total
daily
Perindopril 2 mg once daily 8–16 mg once daily NA
Quinapril 5 mg twice daily 20 mg twice daily NA
Ramipril 1.25–2.5 mg once
daily
10 mg once daily NA
Trandolapril 1 mg once daily 4 mg once daily NA
ARB
Candesartan 4–8 mg once daily 32 mg once daily 24 mg total daily
Losartan 25–50 mg once
daily
50–150 mg once
daily
129 mg total daily
Valsartan 20–40 mg once
daily
160 mg twice daily 254 mg total daily
