We found instructive the article by the Large State Peer Review Organization Consortium1 suggesting underuse of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure. It reinforces previous similar demonstrations obtained both in general practice2 and in hospital settings,3,4 and again, it provides disturbing evidence that elderly patients are at greatest risk of underprescription of ACE inhibitors. However, some considerations seem warranted. Although assumed, there is a lack of evidence of benefit from the use of ACE inhibitors in patients older than 70 years; indeed, all the major randomized controlled trials have systematically excluded older patients.5 Moreover, the simple documentation of use does not exclude the possibility that inappropriate doses are prescribed. It is documented that the dosages routinely used in clinical practice are substantially lower than those used in the trials, especially in the elderly.6
Gambassi G, Carbonin P, Bernabei R. Angiotensin-Converting Enzyme Inhibitors for Elderly Patients With Congestive Heart Failure. Arch Intern Med. 1998;158(1):97. doi:
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