BMJ  2005;331:159 (16 July), doi:10.1136/bmj.331.7509.159-b

Letter

Drug combinations and all cause mortality in heart disease

Dosages and types of ACE inhibitors need to be known

The first 150 words of the full text of this article appear below.

EDITOR—The study reported by Hippisley-Cox and Coupland leads to much generalisation.1 Firstly, I am concerned that the data on angiotensin converting enzyme (ACE) inhibitors, contradict convention. Secondly, without actual data in front of me, I have to guess at the meaning of the ACE inhibitor data.

As the EUROPA, PROGRESS, ANBP, PEACE, TRACE, SAVE, and HOPE studies have shown, there is a great disparity in efficacy of ACE inhibitors. As Doulton et al say in their review of ACE inhibitor and angiotensin receptor blocker trials, the ACE inhibitor trials were described as mostly using submaximal doses or a once daily dose of shorter acting ACE inhibitors.2 It has long been known that the more efficacious trials of ACE inhibitors used a large dose, as the perindopril investigators found out in PROGRESS and EUROPA. The trandalopril investigators also saw this disparity in PEACE and TRACE. What were the ACE . . . [Full text of this article]

Frank A Snyder, physician

Wilmington Internal Medicine 2215 Canterwood, Wilmington, NC 28401, USA slude1@aol.com


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Relevant Article

Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis
Julia Hippisley-Cox and Carol Coupland
BMJ 2005 330: 1059-1063. [Abstract] [Full Text] [PDF]

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