Inhibition of Angiotensin-Converting Enzyme in Congestive Heart Failure

To the Editor: The recent study by Packer et al. (Oct. 2 issue),¹ comparing the effects of enalapril and captopril in heart failure, has problems with study design that make the implications of the study less broad than the investigators intended. The dosages of the inhibitors of angiotensin-converting enzyme (150 mg of captopril per day and 40 mg of enalapril per day) are larger than those currently used by most clinicians. Captopril was originally investigated in doses of up to 150 mg three times a day. However, the tendency over recent years has been to use this drug in doses…