Update on the interaction between aspirin and angiotensin-converting enzyme inhibitors

We summarized recent published literature regarding the significance of an interaction between aspirin and angiotensin-converting enzyme (ACE) inhibitors in patients with various cardiovascular diseases. A MEDLINE search (January 1998-July 1999) was performed and abstracts from the 1999 American College of Cardiology and 1998 American Heart Association annual scientific sessions were reviewed to identify pertinent studies. Material for discussion was identified through a MEDLINE search from January 1996-July 1999 and through cited references. The results of several studies added to our understanding of the clinical ramifications of an aspirin-ACE inhibitor interaction, but also introduced questions. These studies are largely contradictory, but do reiterate the possibility of an interaction, if only in certain subsets of patients. Low dosages (< or = 100 mg/day) of aspirin appear to be safer in this regard than higher dosages. The frequency and severity of the interaction and possible predisposing factors await future research.