The antihypertensive
efficacy of
captopril and enalapril may be reduced by high-dose
aspirin in about 50% of patients. Low-dose
aspirin (less than or equal to 100 mg daily) appears to have little effect. It is unclear whether
aspirin attenuates the benefits of
ACE inhibitors in coronary artery disease and heart failure. The likelihood of an interaction may depend on disease state (more likely with non-ischaemic disease).
For hypertension, no action needed if low-dose
aspirin is used. Suspect an interaction with high-dose
aspirin if the ACE inhibitor seems less effective, or blood pressure
control is erratic. Consider an alternative analgesic, but note that NSAIDs interact in the same way as high-dose
aspirin. For heart failure it is generally advised that concurrent use is best avoided, unless a specific indication (e.g. coronary
heart disease, stroke) exists.