Does aspirin interfere with the therapeutic efficacy of angiotensin-converting enzyme inhibitors in hypertension or congestive heart failure?

We conducted a MEDLINE search of published literature from 1966 to January 1998 regarding the impact of aspirin (ASA) on the therapeutic effect of angiotensin-converting enzyme (ACE) inhibitors in hypertension and congestive heart failure. Selected references from these articles and results of recent clinical trials were also included. By inhibiting cyclooxygenase, ASA may interfere with the prostaglandin-mediated hemodynamic effects of ACE inhibitors. Although other nonsteroidal antiinflammatory drugs may increase blood pressure in hypertensive patients taking an ACE inhibitor, low-dosage (< or = 100 mg/day) ASA does not. However, higher dosages of ASA may attenuate the benefits of ACE inhibitors in patients with hypertension and/or congestive heart failure (CHF). Low-dosage ASA appears to interact little with ACE inhibitors, whereas higher dosages may produce a more significant interaction. Patients with CHF may also be more susceptible to this interaction because of underlying disease.