What does ATLAS really tell us about 'high' dose angiotensin-converting enzyme inhibition in heart failure?

The Assessment of Treatment with Lisinopril and Survival (ATLAS) results have been widely quoted by proponents advocating the use of 'high' doses of angiotensin-converting enzyme (ACE) inhibitors for the treatment of heart failure. In ATLAS, however, the relative benefits of 'high' versus 'low' dose ACE inhibition were small. Intermediate doses of ACE inhibitors proven effective in previous placebo-controlled trials provide benefit that appears likely to equal or exceed the benefit from 'high' dose ACE inhibition. Therefore, we recommend that physicians continue to prescribe ACE inhibitors for patients with heart failure based on the target doses used in the placebo-controlled trials and not on the 'high' dose target used in ATLAS.