Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: In their Scientific Review article
about the management of advanced heart failure, Dr Nohria and colleagues1 suggested that angiotensin II receptor blockers
(ARBs) are a reasonable alternative for patients who cannot tolerate angiotensin
converting enzyme (ACE) inhibitors because of severe cough or angioedema.
Although we agree that ARBs, or a combination of hydralazine and a nitrate,
constitute a reasonable alternative in patients experiencing persistent cough
associated with receiving ACE inhibitors, we believe that ARBs in patients
with a history of an ACE inhibitor–associated angioedema should only
be used with extreme caution, if at all.
de Denus S, Spinler SA. Treatment of Congestive Heart Failure. JAMA. 2002;287(17):2209-2210. doi:10.1001/jama.287.17.2209