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Aug 01, 2012

High-Dose ACE Inhibitors and ARBs

Treatments such as ACE inhibitors and ARBs can help improve outcomes as well as quality of life.

ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are two types of drugs that help relax the blood vessels, making it easier for the heart to pump blood. ACE inhibitors and ARBs are most commonly used to treat heart failure, since they increase blood flow and help reduce the workload on the heart. Because these drugs are so effective in improving outcomes for patients with heart failure, guidelines recommend use of ACE inhibitors and ARBs in relatively high doses. However, it turns out that many patients are prescribed lower doses than recommended and some wonder if this could have negative health effects for patients.

To test this idea, researchers followed Canadian heart failure patients from 1998 to 2007, monitoring their treatments and tracking their outcomes. Findings of this study, which were recently published in the Journal of the American Medical Association, showed that nearly 1/3 of more than 43,000 patients were prescribed low-doses of ACE inhibitors or ARBs. Compared with those prescribed medium or high doses of these drugs, patients taking low-dose medications were much more likely to be hospitalized and had significantly greater risk for death. On the other hand, patients taking high-doses of the medications were more likely to have better outcomes and less risk of death. And overall, ACE inhibitors were found to be more effective than ARBs in treating heart failure.

So what do these findings mean? In a nutshell, doctors should try to prescribe high doses of ACE inhibitors or ARBs, when possible, to help improve outcomes for patients with heart failure. Also, this was the first study of its kind to compare different doses of ACE inhibitors and ARBs. Therefore, further research is needed to better understand the impact of dosage of these drugs on heart failure outcomes.

Questions for You to Consider

  • What is heart failure?

  • Heart failure occurs when the heart is unable to pump enough blood to the rest of the body. Although there is no cure for heart failure, treatments such as ACE inhibitors and ARBs can help improve outcomes as well as quality of life.
  • How is heart failure treated?

  • Although treatments for heart failure rarely reverse or stop the progression of the disease, various therapies can help slow the progression of heart failure, such as medications, surgeries and medical devices. Which therapies are best depends on each individual patient.