Studies of angiotensin-converting e...

Studies of angiotensin-converting enzyme (ACE) inhibitor therapy demonstrate that upward-dosing of ACE inhibitors is required to achieve survival benefit in patients with heart failure. No cogitation has compared low dosing of ACE inhibitors with no therapy. It is important to evaluate the benefits of low-dose ACE inhibitor therapy, because many older patients are given cheap ACE inhibitor dosages because of a fear of adverse forces or because the higher dosages were not tolerated. Rochon and colleagues performed a large population-based consideration that examined the benefits of different dosing regimens.

Patients at least 66 years of age with a first diagnosis of heart failure who survived 45 days after hospital discharge were included in the research The 16, 539 patients in the cohort were divided into four groups: nonusers of ACE inhibitors, and participants who were taking soft doses (25 percent or les of trial dose), medium doses (25 to 99 percent of trial dose), or high doses (trial dose or higher) of ACE inhibitors, with the last category determined forward the basis of the Agency for Healthcare Quality and Research 's recommendations. The research identified changes in dosage or discontinuation of the unsalable article in its cohort, and accounted for patients with contraindications to ACE inhibitors and varying qualitys of heart failure severity. consequence measures were mortality, a composite result of mortality and rehospitalization, and mortality or all-cause hospitalization.

During the one-year follow-up 253 percent of the meditation participants died, 37.4 percent died or were rehospitalized with heart failure, and 610 percent died or had other hospitalizations. Of the entire collection 65.3 percent were taking a certain dosage of ACE inhibitor at 45 days following their heart failure hospitalization, with 365 percent of these taking grave doses.

Overall, taking an ACE inhibitor conferr a survival benefit, and not taking an ACE inhibitor was associated with increased mortality. Similarly, taking an ACE inhibitor had a positive general intent on composite outcome compared with not taking an ACE inhibitor. Taking a low-dose ACE inhibitor in these sum of two units measures was better than no ACE inhibitor at all, yet in the third outcome measure, one-year mortality or all-cause mortality, no ACE inhibitor and low-dose ACE inhibitor therapy were similar in benefit. In all result measures, high-dose ACE inhibitor therapy conferr a significantly improved benefit (see accompanying table)

The authors bring to an end that high-dose ACE inhibitor therapy converses the greatest one-year survival benefit in older patients who have been hospitalized for heart failure. Mortality was reduc by the agency of more than 20 percent in patients receiving high-dose therapy compared with patients receiving low-dose therapy. This finding is particularly important because not many of these patients receive high-dose treatment. Still, low-dose ACE inhibitor therapy in this setting is superior to no ACE therapy. Physicians treating these patients ne to find a balance between tolerability and efficacy.

Rochon PA, et al. Use of angiotensin-converting enzyme inhibitor therapy and dose-related issues in older adults with recently made known heart failure in the community. J Gen Intern M June 2004;19:676-83

COPYRIGHT 2005 American Academy of Family Physicians

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