Role and Optimal Dosing of Angiotensin-Converting Enzyme Inhibitor Therapy

Angiotensin-converting enzyme (ACE) inhibitors form a mainstay of therapy in patients who have left ventricle systolic dysfunction. Furthermore, ACE inhibitors may help prevent heart failure in patients who have high-risk cardiovascular profiles. Data are not available to recommend their use in patients who have heart failure and preserved ejection fraction. Although ACE inhibitors likely have a class effect in patients who have heart failure, the use of ACE inhibitors that reduced morbidity and mortality in clinical trials is recommended because studies have defined a dose for these agents that modifies the natural history of the disease. Attempts should be made to up-titrate patients to target doses of ACE inhibitors that have been used in clinical trials, if tolerated.