Inhibitors of the Renin-Angiotensin- Aldosterone System: Recommendations Class I 1. ACE inhibitors should be started and continued in- definitely in all patients with LVEF less than 0.40 and in those with hypertension, diabetes mellitus, or sta- ble CKD (Section 7.6), unless contraindicated.275,276 (Level of Evidence: A) 2. ARBs are recommended in patients with HF or MI with LVEF less than 0.40 who are ACE inhibitor in- (Level of Evidence: A) 3. Aldosterone blockade is recommended in patients post MI without significant renal dysfunction (cre- atinine >2.5 mg/dL in men or >2.0 mg/dL in women) or hyperkalemia (K+ >5.0 mEq/L) who are receiving therapeutic doses of ACE inhibitor and beta blocker and have a LVEF 0.40 or less, diabetes mellitus, or (Level of Evidence: A) Class IIa 1. ARBs are reasonable in other patients with cardiac or other vascular disease who are ACE inhibitor in- (Level of Evidence: B) Class IIb 1. ACE inhibitors may be reasonable in all other pa- tients with cardiac or other vascular disease.281,282 (Level of Evidence: B) ACE inhibitors reduce mortality in patients with recent MI, primarily those with LV dysfunction (LVEF <0.40) with or without pulmonary congestion.283 285 In patients with normal LV function (including patients with diabetes mellitus), total mortality and MACE (including HF) are reduced. 