2. Duration of Therapy

There is no basis for limiting ACE inhibitor therapy duration when utilized to manage hypertension, heart failure, and proteinuria associated with diabetic nephropathy, as these conditions require chronic treatment. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) focused update supports that ACE inhibitor use reduces cardiovascular morbidity and mortality in heart failure patients with reduced ejection fraction [25]. Additionally, the ACC/AHA 2013 guidelines for ST-elevation myocardial infarction (STEMI) recommend immediate ACE inhibitor therapy within the first 24 hours in patients with an anterior infarction, heart failure, or ejection fraction less than 0.40 who have no contraindications for ACE inhibitor use as well, as indefinite therapy with ACE inhibitors post-myocardial infarction for these patients [26]. The ACC/AHA 2014 guidelines for unstable angina/non-STEMI patients recommend immediate ACE inhibitor therapy within first 24 hours in those with pulmonary congestion or left ventricular ejection fraction less than 0.40, and no hypotension or contraindications to ACE inhibitor therapy [27]. Guidelines also recommend prolonged use of ACE inhibitors in patients with heart failure, left ventricular ejection fraction less than 0.40, hypertension, diabetes mellitus, or stable CKD without contraindications to ACE inhibitor therapy to reduce cardiovascular mortality [28].