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What is the role of angiotensin converting enzyme inhibitors (ACE) inhibitors following myocardial infarction ?

What is the role of angiotensin converting enzyme inhibitors (ACE) inhibitors following myocardial infarction ?

Several large trials (SAVE, AIRE, SMILE, TRACE, GISSi-lll and IS1S-IV) have shown both short- and long-term improvement in survival with ACE inhibitor therapy. The benefits are greatest in patients with low ejection fractions, large iufa, ction~ tn ulinical evidence of heart failure.

• The AIRE (Acute Infarction Ramipril Efficacy) and the AIREX (AIRE Extension) trials assessed the long-term (mean follow-up 59 months) efficacy of ramipril compared with placebo in 603 patients with heart failure after myo-cardial infarction. Treatment with ramipril resulted in a large and sustained reduction in mortality (relative risk reduction 36%).

• The SAVE (Survival and Ventricular Enlargement) Trial compared the effect of captopril or placebo in 2231 patients up to 16 days post myocardial infarction with an asymptomatic ejection fraction ?

What is the role of ACE inhibitors in hypertension ?

What is the role of ACE inhibitors in hypertension ?


• In the HOPE (Heart Outcomes Prevention Evaluation) study the use of ramipril was associated with reductions of stroke, coronary artery disease and heart failure in both hypertensive and non-hypertensive groups as compared to placebo (N Engl J Med 2000; 342: 145-53).

• In the Captopril Prevention Project (CAPPP) the risk of stroke was slightly greater with ACE inhibitor based therapy than with diuretic-based or beta-blocker based therapy but the higher baseline and follow-up blood pressure among patients assigned the ACE inhibitor regimen may largely or entirely account for the excess risk of stroke (Lancet 1998; 353:611-16).

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