Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 32.In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac 6.2.7.5 Contraception and pregnancy In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and 6.2.7.6 ACE inhibitors and beta-blockers 33.Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010 ] Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 34.Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. [2003] 35.Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 6.2.7.6.1 Starting and monitoring ACE inhibitors 36.Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 37.Measure serum sodium and potassium and assess renal function before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment.[2010,amended 2018] 38. Measure blood pressure before and after each dose increment of an ACE inhibitor. 