CHF Patient NOT on ACE Inhibitor

[cindy]

My 62 year old mother is on the following medications to treat CHF:
Torsemide
Metolazone
Spironolactone
Metoprolol
Coreg
Digoxin
Coumadin

She is also a diabetic currently on Humalog & Lantus.

From my research, it does not appear that any of these medications are ACE Inhibitors which I've read are very good at treating CHF. Can someone tell me why the doctor doesn't have her on one of those? Her current infraction is about 10-15% and a couple of weeks ago the doctor told me that it won't be much longer until she passes. I just am concerned that maybe his treatment of her is not as good as it could be.

Any help would be appreciated.

Thank You!

Cindy
I'm not sure the 1st response answered my question. I looked up the medications and know what they are but none are ACE inhibitors.

[mamapharmD]

You are correct that an ACE inhibitor is indicated in CHF patients. It also is recommended in diabetics because it has a protective effect on the kidneys. Although it is hard to say for sure, he may be concerned about her current kidney function or blood pressure. Your kidneys need to be working properly in order for an ACE inhibitor to have the desired effect. In my experience, metolazone is reserved for patients who's kidney function is poor. Also, the first 5 medications you listed all have blood pressure lowering effects. He may be concerned that her blood pressure will go to low if he adds yet another one. I do see one potential problem. Coreg and metoprolol are in the same class. This is a duplicate therapy and therefore one of them is unnessesary and may increase side effects. I would address this with her doctor right away and then ask him why he does not have her on an ACE inhibitor for her CHF and diabetes.