REPLY
Use of Angiotensin-Converting Enzyme Inhibitors in Heart Failure and Renal Insufficiency
Michael G. Shlipak, MD, MPH
1 June 2004 | Volume 140 Issue 11 | Page 932
IN RESPONSE:
I appreciate Dr. Ahmed's comments, and I agree that ACE inhibitors are likely to be beneficial in patients with systolic heart failure and renal insufficiency. The observational studies that demonstrate ACE inhibitor effectiveness in this setting are reassuring (1-3). However, subgroup analyses from randomized clinical trials of ACE inhibitors would add valuable and more definitive evidence to support the use of these agents in these patients.
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Author and Article Information
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From Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, CA 94121.
1. Ahmed A, Kiefe CI, Allman RM, Sims RV, DeLong JF. Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications. J Am Geriatr Soc. 2002;50:1659-66. [PMID: 12366619].
2. Frances CD, Noguchi H, Massie BM, Browner WS, McClellan M. Are we inhibited? Renal insufficiency should not preclude the use of ACE inhibitors for patients with myocardial infarction and depressed left ventricular function. Arch Intern Med. 2000;160:2645-50. [PMID: 10999979].
3. Shlipak MG, Browner WS, Noguchi H, Massie B, Frances CD, McClellan M. Comparison of the effects of angiotensin converting-enzyme inhibitors and beta blockers on survival in elderly patients with reduced left ventricular function after myocardial infarction. Am J Med. 2001;110:425-33. [PMID: 11331052].
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