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Vol. 5, No. 2, 2005
Issue release date: April–June 2005
Heart Drug 2005;5:89–99

ACE Inhibitors for Older Patients with Heart Failure: A Review of Evidence, Practice Patterns and Challenges

Peterson P.N. · Masoudi F.A.
aDepartment of Medicine, Division of Cardiology, University of Colorado Health Sciences Center, and bDepartment of Medicine, Division of Cardiology, Denver Health Medical Center, Denver, Colo., USA

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Heart failure is predominantly a condition of the elderly and is associated with substantial mortality, morbidity and functional limitation. In clinical trials of patients with left ventricular systolic dysfunction (LVSD), angiotensin-converting enzyme (ACE) inhibitors reduce the burden of heart failure. Clinical trials, however, have largely excluded older persons. This paper reviews the evidence for efficacy and effectiveness of ACE inhibitors, current patterns of use of these important agents and the challenges of prescribing ACE inhibitors for older patients with heart failure. The existing literature indicates that (1) despite a relative paucity of data from randomized controlled trials, observational studies suggest that the elderly with LVSD are as likely to benefit from ACE inhibitors as younger patients; (2) ACE inhibitors are underused in older persons despite guideline recommendations, and (3) the older population presents specific challenges in applying the clinical evidence supporting ACE inhibitors, including polypharmacy, cognitive impairment and other common comorbid conditions. Nevertheless, the judicious use of ACE inhibitors in eligible older patients will likely improve health outcomes.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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