Was the Enalapril Dose Too Low in the PARADIGM-HF Trial?
Key result
High-dose ACE inhibitors fail to reduce HF mortality versus lower doses but may reduce hospitalizations.
Why the study?
Do higher doses of ACE inhibitors or ARBs reduce mortality or heart failure hospitalizations compared to lower doses in patients with HFrEF?
Population
Patients with heart failure with reduced ejection fraction (HFrEF)
Comparison
Higher or maximum recommended doses of ACE… vs Lower or intermediate doses of ACE inhibitors or…
Design
Review
Authors
Discussion
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Member takes
Implication
May support intermediate ACE inhibitor dosing in HFrEF to limit adverse effects; leaves open prospective trials on hospitalizations.
Structured PICO
Do higher doses of ACE inhibitors or ARBs reduce mortality or heart failure hospitalizations compared to lower doses in patients with HFrEF?
P
Population
Patients with heart failure with reduced ejection fraction (HFrEF)
I
Intervention
Higher or maximum recommended doses of ACE inhibitors or angiotensin receptor blockers
C
Comparator
Lower or intermediate doses of ACE inhibitors or angiotensin receptor blockers
O
Outcome
Mortality and heart failure hospitalizationshard clinical
Current evidence does not show that maximum recommended doses of ACE inhibitors significantly reduce mortality compared to intermediate doses in HFrEF, though they may reduce HF hospitalizations.
Cite This Study
Bernardez‐Pereira et al. (2018) conducted a review in Heart failure with reduced ejection fraction. ACE inhibitors (enalapril) vs. Intermediate or lower dose was evaluated on Mortality and heart failure hospitalizations. Higher doses of ACE inhibitors have not been prospectively shown to significantly reduce mortality compared with lower doses in heart failure, though they may decrease hospitalizations.