Vnitr Lek 2003, 49(4):322-5;

[Administration of maximal or median doses of drugs in cardiovascular diseases?].

J Spácil: III. interní klinika 1. lékarské fakulty UK a VFN, Praha.

In recent years some specialists recommend to treat patients with cardiovascular diseases with maximal doses of drugs and refer to the results of extensive clinical studies. On critical evaluation of some it seems that the results are not interpreted accurately and that the highest doses of drugs (or combined treatment) do not produce better results than the use of smaller doses. This applies e.g. to the study HOT with felodipine in hypertensive patients and patients with cardiac insufficiency in the ATLAS study with lisinopril and the MERIT-HF study with metoprolol. It applies also the HOPE study with ramipril in secondary prevention in subjects with cardiovascular diseases. Efforts to achieve as low as possible lipid values has also some pitfalls. The author recommends to treat comprehensively all patients and to select maximal doses only in selected subjects.