What Is The Optimal Dosage Of Ace Inhibitor In Heart Failure?

The target dosages of angiotensin-converting enzyme (ACE) inhibitors are those with proven survival benefit in the major prospective trials: perindopril 4 mg once daily, captopril 50 mg three times daily, enalapril 10 mg twice daily, lisinopril 10 mg once daily, ramipril 5 mg twice daily, zofenopril 30 mg twice daily (Table). Therapy is best initiated using a low dosage of a relatively short-acting drug (eg, captopril or enalapril), which is then cautiously uptitrated to the target dosage. There is no clear evidence that low dosages are as effective as the high optimal dosages proposed in the trials.

Modified from: Guidelines for the Diagnosis and treatment of chronic heart failure. Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology: W.

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J. Remme and K. Swedberg (Co-Chairmen). Eur Heart

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J. 2001;22: 1527-1560. Copyright ‚© 2001, The European Society of Cardiology.

Further reading.

Cohn

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JN,

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Johnson G, Ziesche 5, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl

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J Med. 1991;325:303-310.

Homig B, Kohler C, Drexler H. Role of bradykinin in mediating vascular effects of angiotensin-converting enzyme inhibitors in humans. Circulation. 1997;95:1115-1118.

Kober L, Torp-Pedersen C, Carlsen

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JE, et al. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl

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J Med. 1995;333:1670-1676.

Loskutoff D

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J, Sawdey M, Mimuro

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J. Type I plasminogen activator inhibitor. Prog Hemost Thromb. 1989;9: 87-l 15.

Mancini GB

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J, Henry GC, Macaya C, et al. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patient with coronary artery disease. The TREND (Trial on Reversing Endothelial Dysfunction) Study. Circulation. 1996;94:258-265.

Pfeffer MA, Braunwald E, Moye LA, et al. Effects of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survivci and ventricular enlargement trial. The SAVE Investigators. N Engl

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J Med. 1992;327:669-677.

Recommended ACE-inhibitor maintenance dose ranges (manufacturers' or regulatory recommendations).

Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology: W.

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J. Remme and K. Swedberg (Co-Chairmen). Guidelines for the Diagnosis and treatment of chronic heart failure. Eur Heart

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J. 2001 ;22:1527-1560.

The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators.

Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993,342: 821 -828. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl

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J Med. 1992;327:685-691.

The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl

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J Med. 1991;325:293-302.

Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991 ;83: 1849* 1865.

Keywords.

Drug; ACEI; dosage; recommendation.

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