Does the addition of losartan improve the beneficial effects of ACE inhibitors in patients with anterior myocardial infarction? A pilot study

Pasquale, Pietro Di; Bucca, Vincenzo; Scalzo, Sebastiano; Cannizzaro, Sergio; Giubilato, A; Paterna, Salvatore

doi:10.1136/hrt.81.6.606

Cited by 22 publications

(30 citation statements)

References 23 publications

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“…An older randomized trial showed a reduction in mortality with an increased risk of hypotension in patients treated soon after presentation in the inpatient setting. 183 Several trials showed a reduction in the rate of heart failure and mortality in patients treated soon after fibrinolysis, [363][364][365] and several others showed no benefit with the early or prehospital use of angiotensin converting enzyme. 364,366,367 In conclusion, although ACE inhibitors and ARBs have been shown to reduce long-term risk of mortality in patients suffering an AMI, there is insufficient evidence to support the routine initiation of ACE inhibitors and ARBs in the prehospital or ED setting (Class IIb, LOE C).…”

Section: Ace Inhibitors In the Prehospital Settingmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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Section: Ace Inhibitors In the Prehospital Settingmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

240

167

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“…The primary search for clinical trials on MRAs and left ventricular dysfunction generated 559 potentially relevant articles, of which 19 met the selection criteria and were published between 1995 and 2011. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] A flow diagram schematized the process of selecting and excluding articles with specific reasons (Figure 1). Five of 19 qualified trials recorded outcomes within >1 time point in treatment, yielding a total of 26 studies conducted exclusively in subgroup analyses by treatment durations.…”

Section: Eligible Trialsmentioning

confidence: 99%

Impact of Mineralocorticoid Receptor Antagonists on Changes in Cardiac Structure and Function of Left Ventricular Dysfunction

et al. 2013

Circ: Heart Failure

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“…In the case of ARBs and MI risk, one would expect to observe an In our inclusive, systematic review of 25 trials, [13][14][15][16][17][18][19][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]53,[55][56][57] 68 711 patients at risk for MI, and Ͼ4000 events, we now have even stronger evidence that ARBs do not increase the risk of MI, with a pooled OR of 1.03 (95% CI 0.93 to 1.13). Although few of these studies were designed to test equivalence, with a point estimate very close to unity and narrow CIs, it is clear that there is no increased risk of MI associated with ARB use.…”

Section: Do Arbs Increase the Risk Of Mi?mentioning

confidence: 99%

Angiotensin Receptor Blockers Do Not Increase Risk ofMyocardial Infarction

Tsuyuki

McDonald

2006

Circulation

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T he efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors has been well established; these agents have shown an overwhelming and unequivocal benefit in placebo-controlled trials across a spectrum of patients at risk for cardiovascular events. [1][2][3][4][5][6][7][8][9] What has been less clear, however, is whether inhibition of the renin-angiotensin-aldosterone system with angiotensin receptor blockers (ARBs) yields benefits of comparable scale. ARBs selectively inhibit the angiotensin II type 1 receptor, and it is axiomatic that this might offer theoretical advantages over ACE inhibitors by preventing the effects of angiotensin II generated by non-ACE-dependent pathways. 10 -12 In large-scale clinical trials, ARBs have been shown to effectively lower blood pressure, [13][14][15] prevent progression to renal failure in patients with diabetes mellitus and proteinuria, 16 -18 and reduce the incidence of major cardiac events in patients with heart failure. 19,20 These medications are also better tolerated than ACE inhibitors and are recommended in the American College of Cardiology/American Heart Association guidelines for patients with chronic heart failure or left ventricular dysfunction after myocardial infarction (MI) who are unable to tolerate ACE inhibitors and by the 2006 Canadian Cardiovascular Society consensus conference recommendations on heart failure. [21][22][23] Response by Strauss and Hall p 860Debate has surfaced recently on the relative safety of ARBs with respect to MI. In a controversial editorial in the British Medical Journal, 24 Verma and Strauss drew attention to results from certain individual trials and concluded that ARBs increase MI, and they suggested that patients may need to be informed of these risks. Although supported by some, 25 many members of the scientific community criticized the editorial for its nonsystematic approach to the existing data. 26,27 As a "negative" editorial, it received significant attention in the medical community, and concerns about ARB safety were widely reported by the media both locally and internationally.Our group was concerned about these conclusions drawn from selected studies and recently published a systematic review using all published data on the risk of MI and ARBs, and this review showed no increase in risk. 28 Since then, independent systematic reviews and further data have been published that support our assertion that ARBs do not increase the risk of MI. 29 -31 This review will outline the available evidence for ARB safety with respect to MI events in a broad group of high-risk patients. We will also provide our perspective on questions surrounding the role of ARBs for important patient subpopulations. Need for a Systematic Review of All ARB Data on MI RiskSimply put, the best way to answer a clinical question is to systematically and thoroughly evaluate all available data in an unbiased fashion. This is the premise behind the science of systematic reviews or meta-analysis. When we read the editorial by Verma and Strauss...

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Does the addition of losartan improve the beneficial effects of ACE inhibitors in patients with anterior myocardial infarction? A pilot study

Abstract: Conclusion-The data suggest that the combination of captopril plus losartan is feasible in the early treatment of acute myocardial infarction patients, and it appears that this combination has more eVect on ESV than captopril alone in the short term. (Heart 1999;81:606-611)

Cited by 22 publications

References 23 publications

Part 10: Acute Coronary Syndromes

Part 10: Acute Coronary Syndromes

Impact of Mineralocorticoid Receptor Antagonists on Changes in Cardiac Structure and Function of Left Ventricular Dysfunction

Angiotensin Receptor Blockers Do Not Increase Risk ofMyocardial Infarction

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