Start pharmacological treatment in patients with newly diagnosed chronic heart failure by offering an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker, using clinical judgment to decide which to start first, especially if the patient has diabetes or signs of fluid overload NICE CKS.
Begin ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached, with regular monitoring of serum sodium, potassium, renal function, and blood pressure NICE CKS.
Introduce beta-blockers in a 'start low, go slow' manner, assessing heart rate, clinical status, and blood pressure after each titration NICE CKS.
Once the target or maximum tolerated dose of these medications is achieved, monitor treatment monthly for 3 months, then at least every 6 months, and during any acute illness NICE CKS.
If symptoms persist despite optimal doses, consider adding a mineralocorticoid receptor antagonist (MRA) and continue titration and monitoring as above NICE CKS.
In cases where ACE inhibitors are not tolerated, consider angiotensin-II receptor antagonists (ARBs) with similar titration and monitoring protocols NICE CKS.