High-dose ACE inhibitor therapy in heart failure patients resulted in significant reductions in all-cause mortality or hospitalization, cardiovascular hospitalizations, and heart failure hospitalizations.
Does high-dose ACE inhibitor therapy improve clinical outcomes and functional capacity compared to lower doses in patients with heart failure?
Clinicians should attempt to reach target doses of ACE inhibitors in heart failure whenever possible, as higher doses are associated with better clinical outcomes and functional capacity.
Doses of angiotensin-converting enzyme (ACE) inhibitors used in the landmark heart failure trials that demonstrated survival benefit are rarely reached in routine practice. The authors review the current literature regarding optimal dosing of ACE inhibitors in heart failure with specific focus on neurohormonal, functional capacity, and clinical outcomes. Neurohormonal studies have shown that lower ACE inhibitor dosing may provide inadequate suppression of the renin-angiotensin-aldosterone system. Higher doses of ACE inhibitors have resulted in greater increments in exercise and functional capacity. Clinically, patients on high-dose ACE inhibitor therapy had significant reductions in all-cause mortality or hospitalization, cardiovascular hospitalizations, and heart failure-specific hospitalizations. There is, however, conflicting evidence, and so continued uncertainty exists regarding optimal dosing. Despite underutilization of ACE inhibitors, there is insufficient evidence to support lower doses. Likewise, limited data exist for doses higher than those used in the landmark trials. Clinicians should therefore attempt to reach target doses in heart failure whenever possible.
Thomas et al. (Sat,) conducted a review in Heart failure. Angiotensin-converting enzyme (ACE) inhibitors vs. Lower doses was evaluated on Neurohormonal, functional capacity, and clinical outcomes. High-dose ACE inhibitor therapy in heart failure patients resulted in significant reductions in all-cause mortality or hospitalization, cardiovascular hospitalizations, and heart failure hospitalizations.