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 endpoints that include admission to hospital and mortality. This finding is somewhat surprising because a larger benefit with high dose ACE inhibitors was anticipated. The only other RCT that evaluated a low dose and high dose ACE inhibitor strategy in CHF was too small and too short to provide clear answers. Firstly, the use of ACE inhibitors is well established as firstline treatment in CHF, and every patient with clinical manifestations or with asymptomatic left ventricular systolic dysfunction should be considered for ACE inhibitor treatment.