Related Experiment Video

Updated: Aug 21, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
08:35

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

Published on: May 26, 2022

Angiotensin-converting enzyme inhibitor use in elderly patients hospitalized with heart failure and left ventricular

Chandhiran Rangaswamy1, Jeannine I Finn, Todd M Koelling

  • 1University of Michigan, Ann Arbor, Mich., USA.

Cardiology
|November 6, 2004
PubMed

Insights

Elderly heart failure patients receive guideline-based angiotensin-converting enzyme (ACE) inhibitor therapy at similar rates but lower doses than younger patients. This highlights a need to optimize ACE inhibitor dosing in older adults with systolic heart failure.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Pharmacotherapy

Background:

  • Guideline-based care for systolic heart failure recommends angiotensin-converting enzyme (ACE) inhibitors.
  • Previous research indicates elderly populations may receive less ACE inhibitor therapy.
  • This study investigates age-related adherence to heart failure treatment guidelines.

Purpose of the Study:

  • To determine if adherence to guideline-based medical care for heart failure varies by patient age.
  • To analyze the age dependence of ACE inhibitor prescription rates and dosages in hospitalized heart failure patients.

Main Methods:

  • A multicenter observational cohort study included 613 patients with heart failure (ejection fraction ≤40%).
  • Patients were stratified into four age groups: <60, 60-69, 70-79, and ≥80 years.
  • Adherence to guideline-based medical care, specifically ACE inhibitor use and dosage, was measured.

Main Results:

  • ACE inhibitors were prescribed to 83% of eligible heart failure patients, with similar rates across all age groups.
  • Elderly patients (≥70 years) received significantly lower ACE inhibitor dosages compared to younger patients.
  • Predictors of lower ACE inhibitor dosing included lower creatinine clearance, long-term care facility residence, intolerance, lower blood pressure, and no prior heart failure hospitalizations.

Conclusions:

  • Elderly patients with heart failure receive guideline-recommended ACE inhibitor therapy at comparable rates to younger patients.
  • However, older adults are treated with lower doses of ACE inhibitors, indicating a potential area for therapeutic optimization.
Abstract

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Heart Failure Drugs: &#946;-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...