Losartan enhances peak exercise capacity and alleviates symptoms in patients with CHF who are severely symptomatic despite treatment with maximally recommended or tolerated doses of ACE inhibitors.

Doses of angiotensin‐converting enzyme (ACE) inhibitors used in the landmark heart failure trials that demonstrated survival benefit are rarely reached in routine practice. The authors review the current literature regarding optimal dosing of ACE inhibitors in heart failure with specific focus on neurohormonal, functional capacity, and clinical outcomes. Neurohormonal studies have shown that lower ACE inhibitor dosing may provide inadequate suppression of the renin‐angiotensin‐aldosterone system. Higher doses of ACE inhibitors have resulted in greater increments in exercise and functional capacity. Clinically, patients on high‐dose ACE inhibitor therapy had significant reductions in all‐cause mortality or hospitalization, cardiovascular hospitalizations, and heart failure‐specific hospitalizations. There is, however, conflicting evidence, and so continued uncertainty exists regarding optimal dosing. Despite underutilization of ACE inhibitors, there is insufficient evidence to support lower doses. Likewise, limited data exist for doses higher than those used in the landmark trials. Clinicians should therefore attempt to reach target doses in heart failure whenever possible.

Summary What is known and objective Healthcare‐associated pneumonia (HCAP) is an important presentation among hospitalized patients. Standardized definitions of this entity are almost a decade old, and practice patterns have shifted from published guidelines to include empiric coverage with a macrolide, such as azithromycin. Azithromycin is oftentimes included in the empiric treatment regimen for HCAP because of the importance of appropriate empiric antimicrobial coverage, the perceived concern regarding atypical organisms, potential anti‐inflammatory effects of the medication, and positive clinical data among patients with Streptococcal bacteremia. Methods In this review, we systematically investigate data for each of these topics along with clinical data examining the role of azithromycin in HCAP. Results and discussion Our findings indicate that atypical organisms are rare in HCAP, that the anti‐inflammatory actions of azithromycin – although promising – have not produced consistently positive effects in many chronic or acute conditions, and that the data available for azithromycin use in bacteremia are of low quality. A single‐centre cohort indicated that the clinical benefits of azithromycin did not extend to HCAP compared to community‐acquired pneumonia. What is new and conclusion Additionally, there are newer data emphasizing the potential cardiotoxicity of azithromycin, particularly among patients at high risk. All of these data indicate that azithromycin should not be part of the standard empiric treatment for HCAP.