Many CHF Patients Not Receiving– Or Getting Benefits From– High Dose ACE Inhibitors And ARBs Reply

Although current guidelines recommend that ACE inhibitors and angiotensin-receptor blockers (ARBs) be used in high doses in patients with congestive heart failure, many CHF patients currently receive lower than recommended doses of these drugs. In a research letter published online in Archives of Internal Medicine, investigators in Montreal analyzed data from 43,405 patients with a first hospital admission for CHF in Quebec, 73% of whom received an ACE inhibitor and 27% an ARB.

Patients were classified as receiving low-, medium- or high-dose drugs. 29% received a low-dose. The groups were not evenly matched: patients in the high dose group were more likely to have hypertension and diabetes, while patients in the low dose group were more likely to have renal disease.

After adjusting for other factors, the risk of dying or being readmitted to the hospital was significantly reduced in the high dose group. Here are the hazard ratios for ACE inhibitors and ARBs (medium dose serves as the reference):

ACE Inhibitor Mortality:

  • Low dose: 1.16 (1.12-1.20)
  • High dose: 0.90 (0.86-0.94)

ACE Inhibitor Mortality or CHF Readmission:

  • Low dose: 1.09 (1.06-1.24)
  • High dose: 0.93 ((0.89-0.96)
ARB Mortality:
  • Low dose: 1.15 (1.06-1.24)
  • High dose: 0.93 (0.87-1.00)

ARB Mortality or CHF Readmission:

  • Low dose: 1.18 (1.09-1.27)
  • High dose: 0.95 (0.89-1.02)

The authors concluded that “physicians should strive, whenever possible, to treat patients with CHF with high doses of ACE inhibitors or ARBs to improve outcomes.”

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