A Clinical Trial of the Angiotensin-Converting–Enzyme Inhibitor Trandolapril in Patients with Left Ventricular Dysfunction after Myocardial Infarction

Køber, Lars; Torp‐Pedersen, Christian; Je, Carlsen; Bagger, Henning; Eliasen, P; Lyngborg, K; Videbæk, J; Ds, Cole; Auclert, Laurent; Nc, Pauly

doi:10.1056/nejm199512213332503

Cited by 1,574 publications

(728 citation statements)

References 18 publications

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“…[7][8][9] ACE inhibitors therefore have the potential to be of particular clinical benefit in post-AMI patients with antecedent hypertension through several mechanisms. The main effect is likely to relate to prevention or attenuation of adverse ventricular remodelling and infarct expansion, which is more pronounced in patients with prior hypertension.…”

Section: Introductionmentioning

confidence: 99%

The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

1999

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Background: After acute myocardial infarction (AMI), patients with a history of arterial hypertension (AH) have a worse prognosis than normotensives. Whether this adverse risk is beneficially modulated by treatment with angiotensin-converting enzyme (ACE) inhibitors is unknown. We evaluated the prognostic value of antecedent hypertension in post-AMI patients given ACE inhibitor therapy. Methods: We analysed retrospectively data from the AIRE study (randomised, placebo-controlled trial of ramipril in 2006 post-AMI patients with clinical heart failure). A history of AH was present in 28% of the patients. We examined the prognostic value of antecedent hypertension separately among placebo and ramipril treated patients and also the effect of ramipril on clinical outcomes according to whether or not a history of AH was present.

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Section: Introductionmentioning

confidence: 99%

The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

1999

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“…The treatment with ACE inhibitors can also improve the prognosis of patients with acute myocardial infarction with asymptomatic left ventricular systolic dysfunction [9][10][11]. A less marked short-term effect on total mortality was demonstrated when ACE inhibitors were given to all patients with acute myocardial infarction [12,13]. ACE inhibitors prevent the progression of left ventricular systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Czech and Slovak spirapril intervention study (CASSIS)

Widimský

Kremer

Jerie

et al. 1995

Eur J Clin Pharmacol

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“…Suppression of angiotensin activity either with angiotensin‐converting enzyme (ACE) inhibitors or with angiotensin receptor blockers (ARBs) attenuates ventricular dilatation and improves clinical outcomes after acute myocardial infarction (MI) 1, 2, 3, 4, 5. Current guidelines recommend administration of ACE inhibitors or ARBs in patients with acute MI6, 7 and advocate the use of the maximal tolerable dose of those drugs, as used in major trials that established the efficacy of the drugs 6.…”

Section: Introductionmentioning

confidence: 99%

The impact of a dose of the angiotensin receptor blocker valsartan on post‐myocardial infarction ventricular remodelling

Park

Kim

et al. 2018

ESC Heart Failure

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AimsAlthough clinical guidelines advocate the use of the highest tolerated dose of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers after acute myocardial infarction (MI), the optimal dosing or the risk–benefit profile of different doses have not been fully identified.Methods and resultsIn this multicentre trial, 495 Korean patients with acute ST segment elevation MI and subnormal left ventricular (LV) ejection fraction (<50%) were randomly allocated (2:1) to receive maximal tolerated dose of valsartan (titrated up to 320 mg/day, n = 333) or low‐dose valsartan (80 mg/day, n = 162) treatment. The primary objective was to assess the changes in echocardiographic parameters of LV remodelling from baseline to 12 months after discharge. After treatment, end‐diastolic LV volume (LVEDV) decreased significantly in the low‐dose group, but the difference in LVEDV changes was insignificant between the maximal‐tolerated‐dose and low‐dose groups. End‐systolic LV volume decreased significantly in both groups, to a similar degree between groups. LV ejection fraction rose significantly in both study groups, to a similar degree. Changes in plasma levels of neurohormones were also comparable between the two groups. Drug‐related adverse effects occurred more frequently in the maximal‐tolerated‐dose group than in the low‐dose group (7.96 vs. 0.69%, P < 0.001).ConclusionsIn the present study, treatment with the maximal tolerated dose of valsartan did not exhibit a superior effect on post‐MI LV remodelling compared with low‐dose treatment and was associated with a greater frequency of adverse effect in Korean patients. Further study with a sufficient number of cases and statistical power is warranted to verify the findings of the present study.

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A Clinical Trial of the Angiotensin-Converting–Enzyme Inhibitor Trandolapril in Patients with Left Ventricular Dysfunction after Myocardial Infarction

Cited by 1,574 publications

References 18 publications

The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

The prognostic significance of a history of systemic hypertension in patients randomised to either placebo or ramipril following acute myocardial infarction: evidence from the AIRE study

Czech and Slovak spirapril intervention study (CASSIS)

The impact of a dose of the angiotensin receptor blocker valsartan on post‐myocardial infarction ventricular remodelling

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