Congestive heart failure Quiz: Ace Your Exams

A 66-year-old man with a history of coronary artery disease, hypertension, and congestive heart failure presents to the clinic for a routine visit. Current medications include aspirin, atorvastatin, carvedilol, and losartan. The patient has had no recent hospitalizations and no symptoms other than mild dyspnea with daily activities. The patient’s weight has been stable. Temperature is 37.1°C (98.8°F), pulse is 66/min, blood pressure is 112/76 mmHg, respirations are 14/min, and oxygen saturation is 99% on room air. On examination, the lungs are clear and there is no lower extremity edema. Serum BNP today is 150 pg/dL (reference range: <100 pg/dL), and transthoracic echocardiogram one year ago showed an ejection fraction of 55% and impaired left ventricular relaxation. Which of the following medications would potentially provide a mortality benefit if it was added to this patient’s medication regimen ?