Table 1.

Exclusion criteria

1.Participation in a clinical trial of an investigational drug, concurrently, or within the last 30 days prior to enrollment

2.Planned cardiac surgery (eg, severe tricuspid regurgitation with planned tricuspid valve replacement or repair)

3.Previous cardiac transplantation, or on heart transplant wait list

4.Myocardial infarction, stroke, or open-heart surgery in the previous 4 weeks

5.New York Heart Association functional class I or IV symptoms

6.Symptomatic hypotension (fainting, dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache) with a systolic blood pressure < 100 mm Hg at screening, or asymptomatic with pressure < 90 mm Hg at screening

7.eGFR < 30 mL/min per 1.73 m2

8.Reduction in eGFR > 35% from screening to randomization

9.Potassium > 5.2 mmol/L at screening or > 5.4 mmol/L at randomization

10.Known history of angioedema related to previous ACEi or ARB therapy or patients with a history of hereditary or idiopathic angioedema

11.Patients who require concomitant treatment with an ACEi or an ARB or a renin inhibitor for an indication other than heart failure

12.Evidence of hepatic disease as determined by any one of the following: SGOT (AST) or SGPT (ALT) values exceeding 3x the upper limit of normal, bilirubin > 1.5 mg/dL at screening.

13.Unacceptable side effects with ACEis or ARBs

14.Patient with known bilateral renal artery stenosis

15.Cyanosis; substantial left-to-right shunting (Qp/Qs > 1.5); severe mitral, aortic, or pulmonary regurgitation; systemic or pulmonary inflow obstruction with a peak velocity > 1.5 m/s by transthoracic echocardiography; and severe outflow tract obstruction with a peak systolic gradient > 80 mm Hg.

16.Inability to provide informed consent

17.Unable to exercice

18.Pregnant or planned pregnancy during the study

19.Breastfeeding

20.Severe pulmonary hypertension defined as pulmonary pressure equal or superior to systemic pressure

ACEi, angiotensin-converting enzyme inhibitor; ALT, alanine aminotransferase; ARB, angiotensin receptor blocker; AST, aspartate aminotransferase; eGFR, estimated glomerular filtration rate; Qp/Qs, ratio of pulmonary blood flow to systemic blood flow; SGOT, serum glutamic-oxaloacetic transaminase; SGPT, serum glutamic pyruvic transferase.