How high can the dose of ACE inhibitors be pushed in patients with CHF and diabetes mellitus?

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Evidence-Based Answer

In patients with diabetes mellitus, all-cause mortality is reduced with maximum tolerable doses of angiotensinconverting enzyme (ACE) inhibitors compared with less than half the maximally tolerated dose. In patients with congestive heart failure (CHF), moderate- to highdose ACE inhibitor therapy decreases mortality and the frequency of exacerbations compared with lowdose therapy (SOR: B, systematic review of RCTs and retrospective cohort trial).

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