Common heart failure drugs can be safely used at higher, more effective doses, study says

Commonly prescribed heart failure drugs known as ACE inhibitors are often given at lower doses than recommended by leading cardiology associations. A new study of the ACE inhibitor lisinopril written by a researcher at San Francisco VA Medical Center and University of California, San Francisco shows that the vast majority of heart failure patients can safely tolerate higher doses, which have been proven to reduce death and hospitalizations significantly.

The research is published in the latest issue of the Archives of Internal Medicine, written by Barry Massie, MD, SFVAMC chief of cardiology and UCSF professor of medicine, on behalf of the group of researchers who conducted the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial.

Although a number of different ACE inhibitors have been proven in clinical trials to reduce mortality in heart failure patients, a majority of physicians who prescribe these drugs use lower doses than were shown to be effective in clinical trials, Massie said. These doctors have been concerned that the drugs might dangerously lower patients' blood pressure, impair kidney function, or greatly elevate potassium levels, he said.

The new study showed that for a great majority of patients, going from a low dose to a high dose did not cause these severe side effects. "As a rule, giving patients the full recommended dose of ACE inhibitors should cause relatively few problems, if given properly and according to previous studies will reduce deaths and hospitalizations," Massie said.

Nearly five million Americans currently have congestive heart failure, and nearly 50,000 die of the disease each year, according to the American Heart Association. Roughly 70 percent of heart failure patients are prescribed an ACE inhibitor, said Massie.

In this study, Massie and his colleagues performed a secondary analysis of data from the ATLAS trial, a randomized clinical trial of lisinopril, one of the most popular ACE i

Contact: Kevin Boyd
University of California - San Francisco

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