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.
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