High or low dose of angiotensin-converting enzyme inhibitor in patients with left ventricular dysfunction?

Although it is widely accepted that angiotensin-converting enzyme inhibitors have become a cornerstone in the treatment of congestive heart failure, controversy still exists regarding the optimal doses of these drugs to use, and important variations in the daily dose used are seen among different physicians and countries. Nevertheless, objective data indicate that the efficacy of these drugs increases with dose and that most patients with heart failure tolerate the relatively high doses that have been used in large mortality trials. Presently, therefore, and unless new contradictory data become available, every effort should be made to use high doses of angiotensin-converting enzyme inhibitor in heart failure patients.