Lower than conventional doses of captopril in the initiation of converting enzyme inhibition in patients with severe congestive heart failure

Angiotensin converting enzyme (ACE) inhibitors are effective long‐term therapy for congestive heart failure, improving symptoms, exercise tolerance, biochemical anomalies, and mortality. Captopril, in doses of up to 150 mg daily is relatively free of serious adverse effects. A test dose of 6.25 mg normally precedes regular therapy in an attempt to avoid first‐dose hypotension which may also be prevented by reduction in diuretic dosage and by the avoidance of overdiuresis leading to volume depletion. We report two patients who, despite the above precautions developed symptomatic first‐dose hypotension with 6.25 mg, but were subsequently able to recommence captopril therapy by the initial oral administration of doses as low as 1 mg.