The use of angiotensin converting enzyme inhibitors in general practice--appropriate or inappropriate?

To evaluate the pattern of prescribing of angiotensin-converting enzyme (ACE) inhibitors in general practice, related to the primary clinical diagnosis and concomitant medication.

A descriptive survey of general practitioners' prescribing habits, presumptive diagnosis and patient demography over a period of 2 weeks in April 1994.

A stratified quota sample of 22 practices in Northern Ireland.

The major clinical indication for the use of ACE inhibitors was essential hypertension (61.5%) with only a minority usage (19.9%) in congestive heart failure. Co-prescription of drugs with potential for interaction with angiotensin-converting enzyme inhibitors was not uncommon (16.7%). Of the 353 patients with a diagnosis of congestive heart failure, only 64 (18.1%) were receiving ACE inhibitors. The dosages used were lower than recommended for this indication. A significantly higher proportion of elderly patients with heart failure were prescribed hypnotic drugs (14.7% versus 8.3%; p<0.001) and had the co-existence of insomnia (11.8% versus 6.9%; p<0.001) compared to patients without heart failure.

ACE inhibitors were underused in the treatment of congestive heart failure, and were often prescribed in suboptimal dosages. The frequent concurrent prescription of hypnotics and the co-existence of insomnia in heart failure may reflect this therapeutic strategy.