Annals of Saudi Medicine (Jan 2009)

Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure : A cross-sectional study in Palestine.

  • Sweileh Waleed,
  • Sawalha Ansam,
  • Rinno Tamara,
  • Zyoud Sa′ed,
  • Al-Jabi Samah

Journal volume & issue
Vol. 29, no. 2
pp. 119 – 122

Abstract

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Background and Objective: Because high-dose angiotensin-converting enzyme (ACE) inhibitor therapy is desirable in patients with chronic heart failure (CHF), we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine. Methods: This cross-sectional study was conducted between September 2006 and August 2007. All patients admitted with a confirmed diagnosis of CHF and an ejection fraction < 40% were evaluated. After excluding patients with a caution/contraindication to ACE inhibitor use or not taking an ACE inhibitor, we determined the number of patients receiving optimal (captopril 150-300 mg/day, enalapril 20-40 mg/day, ramipril 5-10 mg/day) and suboptimal doses. We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors. Results: Of the 165 patients initially evaluated, 69 (41.8%) had a caution/contraindication (n=28, 40.6%) or were not using an ACE inhibitor (n=41, 59.4%). Of the remaining 96 patients (70.1%), 49/96 (51%) were given an optimal dose while 47/96 (49%) were given a suboptimal dose. Of all patients with CHF and no contraindi--cation (n=137), 88 (64.2%) were either receiving no ACE inhibitor or a suboptimal dose. Only the presence of hypertension was significantly associated with the use of an ACE inhibitor (P=.009, odds ratio=2.7). The use of an optimal dose was not significantly associated with any of the tested factors (age, gender, presence of hyper--tension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis) . Conclusion: Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abun--dance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF, physicians need to be educated about proper dosing of these agents.