DOES ASPIRIN INTERFERE WITH THE THERAPEUTIC EFFICACY OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN HYPERTENSION OR CONGESTIVE-HEART-FAILURE

We conducted a MEDLINE search of published literature from 1966 to Jan uary 1998 regarding the impact of aspirin (ASA) on the therapeutic eff ect of angiotensin-converting enzyme (ACE) inhibitors in hypertension and congestive heart failure. Selected references from these articles and results of recent clinical trials were also included. By inhibitin g cyclooxygenase, ASA may interfere with the prostaglandin-mediated he modynamic effects of ACE inhibitors. Although other nonsteroidal antii nflammatory drugs may increase blood pressure in hypertensive patients taking an ACE inhibitor, low-dosage (less than or equal to 100 mg/day ) ASA does not. However, higher dosages of ASA may attenuate the benef its of ACE inhibitors in patients with hypertension and/or congestive heart failure (CHF). Low-dosage ASA appears to interact little with AC E inhibitors, whereas higher dosages may produce a more significant in teraction. Patients with CHF may also be more susceptible to this inte raction because of underlying disease.