Table A.
Target Doses of Guideline-Directed Medical Therapies
| ACE Inhibitors | Target Dose | Total Daily Target Dose | 50% of Total Daily Target Dose |
|---|---|---|---|
| Captopril | 50 mg, three times daily | 150 mg | 75 mg |
| Enalapril | 10 mg, twice daily | 20 mg | 10 mg |
| Lisinopril | 20 mg, once daily | 20 mg | 10 mg |
| Ramipril | 10 mg, once daily | 10 mg | 5 mg |
| Perindopril | 8 mg, once daily | 8 mg | 4 mg |
| Trandolapril | 4 mg, once daily | 4 mg | 2 mg |
| Benazepril | 40 mg, once daily | 40 mg | 20 mg |
| Fosinopril | 40 mg, once daily | 40 mg | 20 mg |
| Quinapril | 20 mg, twice daily | 40 mg | 20 mg |
| ARB | |||
| Candesartan | 32 mg, once daily | 32 mg | 16 mg |
| Losartan | 100 mg, once daily* | 100 mg | 50 mg |
| Valsartan | 160 mg, twice daily | 320 mg | 160 mg |
| Irbesartan | 300 mg, once daily | 300 mg | 150 mg |
| Telmisartan | 80 mg, once daily | 80 mg | 40 mg |
| Olmesartan | 40 mg, once daily | 40 mg | 20 mg |
| Azilsartan | 80 mg, once daily | 80 mg | 40 mg |
| ARNI | |||
| Sacubitril/valsartan | 97/103 mg, twice daily | 194/206 mg | 98/102 mg† |
| Evidence-Based Beta-Blockers | |||
| Bisoprolol | 10 mg, once daily | 10 mg | 5 mg |
| Carvedilol | 25 mg, twice daily | 50 mg | 25 mg |
| Carvedilol extended release | 80 mg, once daily | 80 mg | 40 mg |
| Metoprolol succinate sustained release | 200 mg, once daily | 200 mg | 100 mg |
Sources for target doses include: 2013 ACCF/AHA heart failure clinical practice guideline,7 2017 ACC/AHA/HFSA heart failure guideline update,4 2017 ACC expert consensus decision pathway for optimization of heart failure treatment,10 and FDA-approved labels.68
ACC/AHA Guidelines recommend losartan 150 mg as target dose. However, because current FDA-approved labeling has 100 mg as the maximal dose, the 100-mg dose is used in the performance measure.
The sacubitril 98 mg and valsartan 102 mg total daily dosing (49/51 mg twice daily) is considered fulfilling the 50% of target dosing criteria. ACE indicates angiotensin–converting enzyme; ARB, angiotensin II receptor blocker; and ARNI, angiotensin receptor–neprilysin inhibitor.