ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor intolerant, unless contraindicated, to reduce morbidity and mortality (136,170,171,189). (Level of Evidence: A) CLASS IIa 1. ARBs are reasonable to reduce morbidity and mortality as alter- natives to ACE inhibitors as rst-line therapy for patients with HFrEF, especially for patients already taking ARBs for other indi- cations,unlesscontraindicated(190 195).(Level of Evidence: A) CLASS IIb 1. Addition of an ARB may be considered in persistently symptomatic patients with HFrEF who are already being treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated (176,196). (Level of Evidence: A) CLASS III: HARM 1. Routine combined use of an ACE inhibitor, ARB, and aldo- sterone antagonist is potentially harmful for patients with HFrEF. (Level of Evidence: C) 6.3.2.4. BETA BLOCKERS CLASS I 1. Use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, and sustained-release metoprolol succi- nate) is recommended for all patients with current or prior symptomsofHFrEF,unlesscontraindicated,toreducemorbidity and mortality (137,172 175,187). (Level of Evidence: A) 6.3.2.5. ALDOSTERONE RECEPTOR ANTAGONISTS See Table 12 for aldosterone receptor antagonists drug dosing. CLASS I 1. Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with NYHA class II IV HF and who have LVEF of 35% or less, unless contraindicated, to reduce morbidity and mortality. Patients with NYHA class II HF should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be consid- ered for aldosterone receptor antagonists. Creatinine should be 2.5 mg/dL or less in men or 2.0 mg/dL or less in women (or estimated glomerular ltration rate >30 ), and potassium should be less than 5.0 mEq/L. 