Significance of Regional Ventriculo-arterial Coupling in Patients With Chronic Heart Failure

Exclusion Criteria

• •1. History of hypersensitivity to any of the study drugs.
• •2. Patients who require treatment with both ACEI and ARB.
• •3. Current acute decompensated HF (exacerbation of chronic HF manifested by signs \& symptoms that may require IV therapy).
• •4. Symptomatic hypotension and/or less than 100 mmHg at the time of screening or less than 90 mmHg at the time of randomization.
• •5. eGFR \< 30 ml/min/1.73m2 as measured by the MDRD formula at Visit 1 (screening) , or a \> 25% decrease after 14 days of active run-in period.
• •6. Serum potassium \> 5.0 mmol/L at screening (Visit 1).
• •7. Acute coronary syndrome, stroke, transient ischemic attack, cardiac, carotid or major vascular surgery, percutaneous coronary intervention (PCI) or carotid angioplasty, within the past 3 months prior to visit 1.
• •8. Coronary or carotid artery disease likely to require surgical or percutaneous intervention within the 6 months after Visit 1.
• •9. Patients with active or unstable bronchospasm or asthma (patients must be on stable regimen of respiratory medications for 1 month prior to Visit 1).
• •10. Right heart failure due to severe pulmonary disease.
• •11. Diagnosis of peripartum or chemotherapy induced cardiomyopathy within the 12 months prior to visit 1.
• •12. Patients with a history of heart transplant or who are on a transplant list or with left ventricular assistance device (LVAD device).
• •13. Documented ventricular arrhythmia with syncopal episodes within past 3 months, prior to visit 1, that is untreated.
• •14. Symptomatic bradycardia or second or third degree heart block without a pacemaker.
• •15. Implantation of a CRT (cardiac resynchronization therapy) device within the prior 3 months from visit 1 or intent to implant a CRT device.
• •16. Presence of hemodynamically significant mitral and/or aortic valve disease, except mitral regurgitation secondary to left ventricular dilatation.
• •17. Presence of other hemodynamically significant obstructive lesions of left ventricular outflow tract, including aortic and sub-aortic stenosis.
• •18. Severe primary pulmonary, renal or hepatic disease.
• •19. Presence of any other disease with a life expectancy of \< 1 year.
• •20. Chronic long-term requirement for NSAIDs (high dose) or COX2 inhibitors, with the exception of aspirin at doses used for CV prophylaxis (≤325 mg o.d.).
• •21. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs
• •22. Subjects get pregnant or will be pregnant within 6 months.