The use of angiotensin converting enzyme inhibitors in general practice—appropriate or inappropriate?

AIMS: To evaluate the pattern of prescribing of angiotensin-converting enzyme (ACE) inhibitors in general practice, related to the primary clinical diagnosis and concomitant medication. DESIGN: A descriptive survey of general practitioners' prescribing habits, presumptive diagnosis and patient demography over a period of 2 weeks in April 1994. SETTING: A stratified quota sample of 22 practices in Northern Ireland. RESULTS: The major clinical indication for the use of ACE inhibitors was essential hypertension (61.5%) with only a minority usage (19.9%) in congestive heart failure. Co-prescription of drugs with potential for interaction with angiotensin-converting enzyme inhibitors was not uncommon (16.7%). Of the 353 patients with a diagnosis of congestive heart failure, only 64 (18.1%) were receiving ACE inhibitors. The dosages used were lower than recommended for this indication. A significantly higher proportion of elderly patients with heart failure were prescribed hypnotic drugs (14.7% versus 8.3%; p<0.001) and had the co-existence of insomnia (11.8% versus 6.9%; p<0.001) compared to patients without heart failure. CONCLUSIONS: ACE inhibitors were underused in the treatment of congestive heart failure, and were often prescribed in suboptimal dosages. The frequent concurrent prescription of hypnotics and the co-existence of insomnia in heart failure may reflect this therapeutic strategy.