A 66-year-old man with ischaemic cardiomyopathy attends for review. Echocardiography shows a left ventricular ejection fraction of 30%, and he remains breathless climbing a flight of stairs despite maximally tolerated perindopril, bisoprolol at target dose and spironolactone. He does not have diabetes (HbA1c 36 mmol/mol) and his eGFR is 58 mL/min/1.73 m². His blood pressure is 112/70 mmHg, heart rate 62/min and regular; the lungs are clear and there is no peripheral oedema. Which one of the following additional medications is most likely to reduce his risk of death and hospitalisation for heart failure?
Keep going — a set of ten like this one, one at a time.
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