Acetylsalicylic Acid and Angiotensin-Converting Enzyme Inhibitors in Heart Failure: A Serious Hemodynamic Interaction? A Systematic Critique

The potential interaction between acetylsalicylic acid and angiotensin-converting enzyme inhibitors in patients with heart failure has received considerable attention lately. Opposing effects on prostaglandin synthesis and metabolism form the theoretical basis of an interaction. A review of the available literature revealed conflicting data from animal studies, human pharmacological studies, and clinical outcome studies. This paper illustrates a possible approach to examining complex and contradictory evidence, through systematic review and critique of the relevant studies. In summary, no substantial clinical evidence could be found that acetylsalicylic acid diminishes the benefits of angiotensinconverting enzyme inhibitors in heart failure.