Angiotensin-converting enzyme inhibitor therapy for coronary artery disease and diabetes mellitus.
OBJECTIVE
To use a population management strategy to increase the proportion of patients with coronary artery disease (CAD) and diabetes receiving target-dose angiotensin-converting enzyme (ACE) inhibitor therapy and to assess the safety and tolerability of this initiative.


METHODS
Prospective cohort.


METHODS
Patients were eligible for enrollment if they were not receiving target-dose ACE inhibitor therapy. Clinical pharmacy specialists were responsible for initiation, titration, and appropriate follow-up of ACE inhibitor therapy.


RESULTS
A total of 453 subjects were enrolled. Their mean age was 67.9 years and 77% were male. At baseline, 30.9% (n = 140) of eligible patients were on no ACE inhibitor therapy and no patients were at the target dose. The mean systolic blood pressure, serum creatinine, and serum potassium values were 128.0 mm Hg, 1.0 mg/dL, and 4.4 mEq/dL, respectively. At follow-up, 8.2% (n = 37; P < .001) were on no ACE inhibitor therapy and 68.7% (n = 311; P < .001) of patients had achieved the target dose. From baseline to follow-up, mean systolic blood pressure decreased 4.4 mm Hg (P < .001). Changes in serum potassium or creatinine were not clinically significant. Of the 142 subjects unable to achieve the target dose, 31 experienced hypotension, 29 did not have the dose increased because of the potential for hypotension, and 23 experienced cough.


CONCLUSIONS
A population management approach to increasing the proportion of patients with CAD and diabetes who receive target-dose ACE inhibitor therapy was effective and safe.
McConnell
Karen J
KJ
Clinical Pharmacy Cardiac Risk Service, Kaiser Permanente of Colorado, Aurora, Colo 80011, USA. karen.mcconnell@kp.org.
Zadvorny
Emily B
EB
Denham
Anne M
AM
Kasten
Shelia L
SL
Hutka
Kara A
KA
Koetting
Cedar R
CR
Merenich
John A
JA
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D004341:Drug Evaluation; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D017706:Lisinopril / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D017706:Lisinopril