How should I initiate and titrate guideline-recommended medications for a patient with heart failure with reduced ejection fraction?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Initiate guideline-recommended medications for heart failure with reduced ejection fraction (HFrEF)

  • Start an ACE inhibitor at a low dose and titrate upwards at short intervals (e.g., every 2 weeks) until the target or maximum tolerated dose is reached .
  • Measure serum sodium, potassium, and assess renal function before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increase .
  • Measure blood pressure before and after each dose increase, including in people with symptoms of postural hypotension .
  • Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months, then at least every 6 months, and at any time the person becomes acutely unwell .
  • If ACE inhibitors are not tolerated, consider an angiotensin-II receptor antagonist (AIIRA), starting at a low dose and titrating similarly, with monitoring of serum electrolytes, renal function, and blood pressure .
  • Start a beta-blocker in a 'start low, go slow' manner, assessing heart rate, clinical status, blood pressure, and tolerability after each titration .
  • Introduce a mineralocorticoid receptor antagonist (MRA) if symptoms persist despite optimal therapy, with similar monitoring of electrolytes, renal function, and blood pressure .

Seek specialist advice if symptoms persist despite optimized standard care, or if there are contraindications or intolerance to first-line medications .

Educational content only. Always verify information and use clinical judgement.