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What does ATLAS really tell us about "high" dose angiotensin-converting enzyme inhibition in heart failure?

J M Nicklas1, J N Cohn, B Pitt

  • 1Department of Medicine, University of Michigan Medical Center, Ann Arbor, USA.

Journal of Cardiac Failure
|July 25, 2000
PubMed

Insights

The Assessment of Treatment with Lisinopril and Survival (ATLAS) trial showed minimal benefits of high-dose angiotensin-converting enzyme (ACE) inhibitors for heart failure. Physicians should use intermediate ACE inhibitor doses based on prior trials, not ATLAS high-dose targets.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The Assessment of Treatment with Lisinopril and Survival (ATLAS) trial results are frequently cited to support high-dose angiotensin-converting enzyme (ACE) inhibitor therapy for heart failure.
  • Previous placebo-controlled trials established the efficacy of intermediate ACE inhibitor doses.

Purpose of the Study:

  • To evaluate the comparative benefits of high-dose versus low-dose ACE inhibition in heart failure treatment.
  • To provide evidence-based recommendations for ACE inhibitor dosing in heart failure management.

Main Methods:

  • Analysis of data from the ATLAS trial comparing high-dose versus low-dose lisinopril.
  • Comparison of ATLAS findings with results from previous placebo-controlled trials of ACE inhibitors in heart failure.

Main Results:

  • The ATLAS trial demonstrated only small relative benefits between high-dose and low-dose ACE inhibition.
  • Intermediate ACE inhibitor doses, effective in prior trials, may offer comparable or superior benefits to high-dose regimens.

Conclusions:

  • Physicians should continue prescribing ACE inhibitors for heart failure based on effective target doses from placebo-controlled trials.
  • The high-dose target used in the ATLAS trial is not recommended as the primary basis for ACE inhibitor prescription in heart failure.

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