For black patients with persistent NYHA class III to IV HF and LVEF For select non-black patients with left ventricular ejection fraction
We suggest treatment with a combination of hydralazine plus nitrate in patients with HF and reduced LVEF who are unable to take either an ACE inhibitor
or an ARB due to drug intolerance (including hyperkalemia
), hypotension, or renal insufficiency
. ARB intolerance can be presumed in patients who develop hyperkalemia or renal insufficiency on ACE inhibitor therapy.