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ACE Inhibitors: Expanded Use, Proper Dosing Examined

Katherine M. Bennett

Despite therapeutic recommendations from ASHP and other health care organizations that patients with heart failure receive angiotensin-converting-enzyme (ACE) inhibitors, less than half of ambulatory patients with this condition do.

Furthermore, according to a report in the November 1999 issue of Pharmacotherapy, patients with heart failure who do take these drugs do so at less-than-optimal dosages.With new research suggesting that more populations of patients may benefit from therapy with ACE inhibitors, pharmacists need to improve the use of this class of drugs. In a study to be published in the Jan. 20 issue of the New England Journal of Medicine, researchers found that ramipril 10 mg/day significantly reduced the rates of death, myocardial infarction, and stroke in a diverse group of more than 9,000 patients not known to have heart failure or left ventricular dysfunction. The authors of the article estimated that by treating 1,000 patients with ramipril for four years, about 150 events could be prevented in about 70 high-risk patients.

A second recent study found that hospital patients with moderate to severe congestive heart failure had a significantly lower risk of death from any cause and fewer hospitalizations for heart failure when treated with lisinopril 32.5 to 35 mg/day rather than 2.5 to 5 mg/day. The authors of the article contend that patients with heart failure should not receive very low dosages of ACE inhibitors unless higher dosages cannot be tolerated.