AKT-0242
An 80-year-old gentleman attends surgery for review of his heart failure.
He was recently diagnosed when he was admitted to hospital with shortness of breath. Echocardiography has revealed impaired left ventricular function. He also has a past medical history of type 2 diabetes mellitus, hypertension and hypercholesterolaemia.
His current medications are: aspirin 75 mg daily, furosemide 40 mg daily, metformin 850 mg TDS, ramipril 10 mg daily, and simvastatin 40 mg daily.
He tells you that the ramipril was initiated when the diagnosis of heart failure was made and has been titrated up to 10 mg daily over the recent weeks. His symptoms are currently stable.
Clinical examination reveals no peripheral oedema, his chest sounds clear and clinically he is in sinus rhythm at 76 beats per minute. His BP is 126/80 mHg.
Providing there are no contraindications, which of the following is the most appropriate treatment to add to his therapy?