Use of ACE inhibitors for secondary prevention
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The role of the renin-angiotensin system as a regulator of blood pressure, body fluids, electrolytes, and neurohormonal activation has been established for more than two decades. The dramatic benefits of angiotensin-converting enzyme (ACE) inhibition on overall mortality, progression to heart failure, and major cardiovascular events were first demonstrated in patients with congestive heart failure (CHF) or left ventricular dysfunction. ACE inhibitors should be prescribed for all patients with symptomatic CHF and for all asymptomatic patients with a left ventricular ejection fraction less than 35% to 40%, unless contraindicated or not tolerated, and therapy should be continued indefinitely. Data have shown that ACE inhibition improves oxidative stress, endothelial and ventricular function, and reduces ventricular remodeling as well as progression of carotid intimal and medial thickening. Current evidence suggests that ACE inhibitors should be prescribed as early as possible for all patients with acute myocardial infarction, unless contraindicated or not tolerated, and that they should be continued for at least 6 weeks; moreover, because these patients automatically qualify as high-risk individuals, indefinite therapy should be considered. Likewise, individuals at increased risk for major cardiovascular events (diabetic patients with additional risk factors and patients with known vascular disease) should be prescribed ACE inhibitors, unless contraindicated or not tolerated, and therapy should be continued indefinitely. There is not sufficient evidence at present to recommend the use of ACE inhibitors after coronary revascularization for the specific goal of preventing restenosis or graft disease, in the absence of decreased ejection fraction, CHF, or a new myocardial infarction.
- Dzau, VJ, Bernstein, K, Celermajer, D (2001) The relevance of tissue angiotensin-converting enzyme: Manifestations in mechanistic and endpoint data. Am J Cardiol 88: pp. 1L-20L CrossRef
- Vaughan, DE (2001) Angiotensin, fibrinolysis, and vascular homeostasis. Am J Cardiol 87: pp. 18C-24C CrossRef
- Mancini, GBJ, Henry, GC, Macaya, C (1996) Angiotensinconverting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (trial on reversing endothelial dysfunction) study. Circulation 94: pp. 258-265
- MacMahon, S, Sharpe, N, Gamble, G (2000) Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, Ramipril, in patients with coronary or other occlusive arterial disease. J Am Coll Cardiol 36: pp. 438-443 CrossRef
- Lonn, EM, Yusuf, S, Dzavik, V (2001) Effects of ramipril and vitamin E on atherosclerosis. The study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Circulation 103: pp. 919-925
- Teo, KK, Burton, JR, Buller, CE (2000) Long-term effects of cholesterol lowering and ACE inhibition on coronary atherosclerosis. The simvastatin/enalapril coronary atherosclerosis trial (SCAT). Circulation 102: pp. 1748-1754
- Pitt, B, O’Neill, B, Feldman, R (2001) The quinapril ischemic event trial (QUIET): evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol 87: pp. 1058-1063 CrossRef
- Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group [no authors listed].N Engl J Med 1987, 316:1429–1435.
- Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators [no authors listed]. N Engl J Med 1991, 325:293–302.
- Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. The SOLVD Investigators [no authors listed]. N Engl J Med 1992, 327:685–691.
- Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators [no authors listed]. Lancet 1993, 342:821–828.
- Kober, L, Torp-Pedersen, C, Carlsen, JE (1995) A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 333: pp. 1670-1676 CrossRef
- Pfeffer, MA, Braunwald, E, Moye, LA (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med 327: pp. 669-677 CrossRef
- Ambrosioni, E, Borghi, C, Magnani, B (1995) The effect of the angiotensin-converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. N Engl J Med 332: pp. 80-85 CrossRef
- Swedberg, K, Held, P, Kjekshus, J (1992) Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. N Engl J Med 327: pp. 678-684 CrossRef
- ISIS-4: a randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58050 patients with suspected acute myocardial infarction. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group [no authors listed]. Lancet 1995, 345:669–685.
- GISSI-3: Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico [no authors listed]. Lancet 1994, 343:1115–1122.
- Indications for ACE inhibitors in the early treatment of acute myocardial infarction. ACE Inhibitor Myocardial Infarction Collaborative Group [no authors listed]. Circulation 1998, 97:2202–2212.
- Estacio, RO, Jeffers, BW, Hiatt, WR (1998) The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulindependent diabetes and hypertension. N Engl J Med 338: pp. 645-652 CrossRef
- Hansson, L, Lindholm, LH, Niskanen, L (1999) Effect of angiotensin-converting enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 353: pp. 611-616 CrossRef
- Tatti, P, Pahor, M, Byington, RP (1998) Outcome results of the fosinopril versus amlodipine cardiovascular events randomized trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 21: pp. 597-603 CrossRef
- Neaton, JD, Grimm, RH, Prineas, RJ (1993) Treatment of mild hypertension study. Final results. JAMA 270: pp. 713-724 CrossRef
- Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Protective Diabetes Study group [no authors listed]. BMJ 1998, 317:713–720.
- Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. HOPE investigators [no authors listed]. N Engl J Med 2000, 342:145–153. Ground-breaking randomized controlled trial having modified everyday practice in the prevention of vascular events in highrisk patients. However, because the Hypertension Optimal Treatment study demonstrated benefits of blood pressure reduction even in normotensive patients, questions remain as to whether at least part of the benefits of the HOPE trial rest on blood pressure reduction alone.
- Effects of ramipril on CV and microvascular outcomes in people with DM: results of the HOPE study and the MICRO-Hope substudy. HOPE Investigators [no authors listed]. Lancet 2000, 355:253–259.
- Randomized trial of a perindopril-based bloodpressure-lowering regimen amond 6,105 individuals with previous stroke or transient ischemic attack. PROGRESS Collaborative Group [no authors listed]. Lancet 2001, 358:1033–1044.
- Faxon, DP (1995) Effect of high-dose angiotensin-converting enzyme inhibition on restenosis: final results of the MARCATOR study, a multicenter, double-blind, placebo-controlled trial of cilazapril. J Am Coll Cardiol 2: pp. 362-369 CrossRef
- Meurice, T, Bauters, C, Hermant, X (2001) Effect of ACE inhibitors on angiographic restenosis after coronary stenting (PARIS): a randomized, double-blind, placebo-controlled trial. Lancet 357: pp. 1321-1324 CrossRef
- Oosterga, M, Voors, AA, Pinta, YM (2001) Effects of quinapril on clinical outcome after coronary artery bypass grafting (the QUO VADIS study). Am J Cardiol 87: pp. 542-546 CrossRef
- Kjoller-Hansen, L, Steffensen, R, Grande, P (2000) The angiotensin-converting enzyme inhibition post revascularization study (APRES). J Am Coll Cardiol 35: pp. 881-888 CrossRef
- Pitt, B, Poole-Wilson, PA, Segal, R (2000) Effect of losartan compared with captopril on mortality in patients with symptomatic HF: randomized trial—the losartan heart failure survival study ELITE II. Lancet 355: pp. 1582-1587 CrossRef
- Cohn, JN, Tognoni, G, Glazer, R (2000) Baseline demographics of the Valsartan Heart Failure Trial. Val-HeFT investigators. Eur J Heart Fail 2: pp. 439-446 CrossRef
- Dahlof, B, Devereux, RB, Faire, U (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 359: pp. 995-1003 CrossRef
- Use of ACE inhibitors for secondary prevention
Current Treatment Options in Cardiovascular Medicine
Volume 5, Issue 1 , pp 51-61
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links