Women had higher ACE inhibitor-related cough (19.6% vs. 8.1%, p=0.04) and men on low-dose ACEi had more hypotension (30.4% vs. 0%, p=0.026) limiting dose tolerance.
Are there sex-based differences in the tolerability and maximum tolerated doses of ACE inhibitors and beta-blockers among cardiac rehabilitation patients?
In a real-world cardiac rehabilitation setting, sex-specific differences in medication tolerability exist, highlighting the need for tailored titration strategies to optimize secondary prevention.
Absolute Event Rate: 0% vs 0%
Abstract Background Women with cardiovascular disease (CVD) are often underrepresented in clinical trials, leading to gaps in understanding sex-specific medication tolerance. Real-world data suggest that women experience more adverse drug reactions (ADRs) and may benefit from lower doses of guideline-directed medical therapy. This study examines sex-based differences in the tolerability of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers (BB) among cardiac rehabilitation (CR) patients in a community setting. Purpose To assess maximum tolerated doses and barriers to up-titration of ACEi and BB among men and women undergoing CR and compare real-world findings with controlled trial data. Methods A retrospective audit of 162 CR patients (54 women, 108 men) was conducted using electronic health records. Medication doses were categorised as low (≤50% target) or high (50%). Tolerability issues (hypotension, dizziness, cough for ACEi; bradycardia, fatigue, shortness of breath for BB) were documented. Results The majority of both men and women were on low doses (ACEi: 66.7% women vs. 78.0% men, BB: 73.5% women vs. 80.8% men). Women were more likely to report ACEi-related cough (19.6% vs. 8.1%, p=0.04), while men on low-dose ACEi experienced more hypotension (30.4% vs. 0%, p=0.026). Although most patients remained on low doses, HR and BP targets were achieved in both sexes, with post-CR mean(range) SBP/DBP at 120 (75) /70 (47) mmHg and HR at 66 (59) bpm. Beta-blocker-related tolerability issues were similar between sexes, with low heart rate being the most common reason for dose limitation (16.9%, p=0.619). Both sexes showed functional capacity (FC) gains post-CR (women: 3.58.3 to 4.78.3 METs, p0.001; men: 5.17.5 to 6.49.9 METs, p0.001), but FC improvements in women on low-dose ACEi were not statistically significant (p=0.093), contrasting the hypothesis that women may benefit from lower doses. Conclusion Sex-specific medication tolerability patterns in a community CR setting do not fully align with trial-based assumptions. Women’s increased ACEi-related cough and men’s greater susceptibility to hypotension highlight potential barriers to optimal dosing. Improved documentation of titration barriers and further research on sex-specific medication strategies in CR are warranted to optimise secondary prevention outcomes. Nevertheless, the attainment of guideline-recommended HR and BP ranges post-CR, along with notable FC improvements particularly in exercisers, reinforces the overall efficacy of CR in enhancing cardiovascular health and functional recovery.
Lilkova et al. (Sat,) reported a other. Women had higher ACE inhibitor-related cough (19.6% vs. 8.1%, p=0.04) and men on low-dose ACEi had more hypotension (30.4% vs. 0%, p=0.026) limiting dose tolerance.