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ACE Inhibitors Beneficial in Patients Without LV Dysfunction

Angiotensin-converting-enzyme (ACE) inhibitors unquestionably improve outcomes among patients with heart failure. This international study was designed to examine whether ACE inhibitors also are beneficial for high-risk patients without left ventricular dysfunction.

Researchers randomized 9297 patients with histories of coronary disease, stroke, peripheral vascular disease, or diabetes plus another cardiac risk factor to receive either the ACE inhibitor ramipril (10 mg daily) or placebo. No patient had a clinical history of heart failure, and nearly all had ejection fractions of greater than 40 percent. During a follow-up of 4 to 5 years, the incidence of the primary endpoint -- a composite of myocardial infarction, stroke, or cardiovascular death -- was significantly lower in the ramipril group than in the placebo group (14.0 percent vs. 17.8 percent). Each of the 3 components of the composite endpoint occurred significantly less often with ramipril treatment. In addition, ramipril was beneficial in virtually every subgroup examined by the researchers, including the subgroup without hypertension.

Comment: This landmark study, supported in part by the maker of ramipril, certainly will lead to expanded use of the drug. The mean blood pressure of ramipril recipients was only a few mm Hg below that of controls; thus, the benefit probably was mediated by antagonism of other deleterious effects of angiotensin II and aldosterone on the heart and blood vessels. Whether other ACE inhibitors would yield similar outcomes is unclear.

— AS Brett

Published in Journal Watch General Medicine January 25, 2000

Citation(s):

The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000 Jan 20 342 145-153.

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