MRCP2-0228

MRCP2-0228

A 65-year-old man with a history of heart failure is currently taking ramipril 10 mg, furosemide 80 mg, spironolactone 25 mg and bisoprolol 10 mg. He visits the clinic for a review as he is experiencing significant shortness of breath and can only walk a few meters before having to stop. During the examination, bilateral crackles are heard in his chest and he has bilateral swollen ankles with pitting edema. His blood pressure is 145/72 mmHg, pulse is 80 and regular. The following investigations are conducted: haemoglobin 94 g/L (135-177), white cell count 7.3 ×109/L (4-11), platelets 200 ×109/L (150-400), sodium 139 mmol/L (135-146), potassium 4.4 mmol/L (3.5-5), creatinine 153 µmol/L (79-118), and ferritin 10 mcg/L (20-60). Based on his condition, which of the following treatments is most likely to benefit him in the long term?