How high should the dose of angiotensin-converting enzyme (ACE) inhibitors be pushed in patients with chronic heart failure (CHF) and diabetes?
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In therapeutic trials lasting a year or more, patients with heart failure do better with high-dose ACE inhibitor targets (lisinopril 35 mg daily, captopril 50 mg BID, enalapril 30 mg BID) than with lower-dose targets. (SOR B, based on a single randomized controlled trial [RCT] for each dose.) Patients with diabetes and microalbuminuria do best using maximally tolerated doses of ACE inhibitors. (SOR B, based on subgroup analysis in a systematic review.)
Evidence Based Practice 12(8): 15.