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Research Letters | Sep 10, 2012

Improved Outcomes in Heart Failure Treated With High-Dose ACE Inhibitors and ARBs: A Population-Based Study

Giordano Egiziano, BSc; Louise Pilote, MD, PhD, MPH; Hassan Behlouli, PhD; Stella S. Daskalopoulou, MD, PhD, MSc

Arch Intern Med. 2012;172(16):1263-1265. doi:10.1001/archinternmed.2012.2514.

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Elevated doses of angiotensin II–converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have similarly reduced morbidity and mortality in congestive heart failure (CHF) trials.¹^- 2 However, despite the recommendations of consensus CHF guidelines to achieve elevated target doses of ACE inhibitors or ARBs,³^- 4 patients often receive doses that are lower than those used in large clinical trials, possibly owing to adverse effects.²^,5^- 6 We conducted a population-based retrospective cohort study to estimate the effect, in real-world clinical practice, of different doses of ACE inhibitors and ARBs on all-cause mortality and CHF readmission in patients with a first CHF admission.

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Figure. Adjusted hazard ratios (HRs) and 95% confidence intervals for mortality and the combined outcome of mortality or congestive heart failure (CHF) readmission by treatment dose. A, Angiotensin II–converting enzyme (ACE) inhibitor dose. B, Angiotensin receptor blocker (ARB) dose. Sensitivity analyses (bolded rows) have been adjusted with propensity score analyses. Med indicated medium.

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Egiziano G, Pilote L, Behlouli H, Daskalopoulou SS. Improved Outcomes in Heart Failure Treated With High-Dose ACE Inhibitors and ARBs: A Population-Based Study. Arch Intern Med. 2012;172(16):1263-1265. doi:10.1001/archinternmed.2012.2514.

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