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

ABSTRACT

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. 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. 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 contraindication [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 hypertension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis]. Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abundance 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