Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure : A cross-sectional study in Palestine.

• Main Authors: Sweileh Waleed, Sawalha Ansam, Rinno Tamara, Zyoud Sa′ed, Al-Jabi Samah
• Format: Article
• Language: English
• Published: King Faisal Specialist Hospital and Research Centre 2009-01-01
• Series: Annals of Saudi Medicine
• Online Access: http://www.saudiannals.net/article.asp?issn=0256-4947;year=2009;volume=29;issue=2;spage=119;epage=122;aulast=Sweileh

<b>Background and Objective: </b> Because high-dose angiotensin-converting enzyme (ACE) inhibitor therapy is desirable in patients with chronic heart failure (CHF), we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine. <b> Methods: </b> This cross-sectional study was conducted between September 2006 and August 2007. All patients admitted with a confirmed diagnosis of CHF and an ejection fraction &#60; 40&#x0025; were evaluated. After excluding patients with a caution/contraindication to ACE inhibitor use or not taking an ACE inhibitor, we determined the number of patients receiving optimal (captopril 150-300 mg/day, enalapril 20-40 mg/day, ramipril 5-10 mg/day) and suboptimal doses. We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors. <b> Results: </b> Of the 165 patients initially evaluated, 69 (41.8&#x0025;) had a caution/contraindication (n=28, 40.6&#x0025;) or were not using an ACE inhibitor (n=41, 59.4&#x0025;). Of the remaining 96 patients (70.1&#x0025;), 49/96 (51&#x0025;) were given an optimal dose while 47/96 (49&#x0025;) were given a suboptimal dose. Of all patients with CHF and no contraindi--cation (n=137), 88 (64.2&#x0025;) were either receiving no ACE inhibitor or a suboptimal dose. Only the presence of hypertension was significantly associated with the use of an ACE inhibitor (P=.009, odds ratio=2.7). The use of an optimal dose was not significantly associated with any of the tested factors (age, gender, presence of hyper--tension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis) . <b> Conclusion: </b> Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abun--dance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF, physicians need to be educated about proper dosing of these agents.