Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. Setting 287 hospitals in 19 countries.
Main outcome measures All-cause mortality.
Many clinicians remain concerned, however, about safety issues and resort to the use of low-dose ACE inhibitors. The results show a trend toward decreased mortality and a modest reduction in combined end points that include hospitalization and mortality. This finding is somewhat surprising because a larger benefit with high-dose ACE inhibitors was anticipated. Therapy should be initiated with caution, however, especially in elderly patients and in those with renal dysfunction or low blood pressure. Patients should be followed with careful and gradual increases in dose.