Lege Artis Medicinae

[CARDIOVASCULAR PREVENTION BY INHIBITION OF THE ANGIOTENSIN CONVERTING ENZYME IN VIEW OF THE RESULTS OF RECENT TRIALS]

PAPP Előd, TÓTH Kálmán

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

[Angiotensin converting enzyme inhibitors have long been basic drugs in the treatment of heart failure. In the preventive treatment of ischaemic heart disease, however, their mortality-reducing effect has only been proved recently. The HOPE was the first trial that showed a beneficial effect of the angiotensin converting enzyme inhibitor ramipril in patients at high risk for cardiovascular diseases. The EUROPA trial showed a positive role of perindopril in the reduction of hard clinical endpoints in relatively low risk patients with known coronary artery disease. The PEACE trial was designed to show a possible group effect of angiotensin converting enzyme inhibitors, but it failed to demonstrate a beneficial effect of trandolapril in patients with coronary artery disease. The latest data from the EUROPA trial and results from three new prevention trials with perindopril or amlodipine plus perindopril combination and with quinapril have been presented recently. Perindopril was administered in patients over 65 years with previous myocardial infarction and with good left ventricle function in the PREAMI study. By the end of the study period, the combined end point and remodelling had decreased significantly. The ASCOT-BPLA trial (amlodipine plus perindopril versus beta-blocker plus diuretic) showed a reduction in all coronary events, in the risk of stroke and in the prevalence of new-onset diabetes mellitus. Quinapril was used in the IMAGINE trial in patients after coronary bypass surgery; the results did not support the hypothesis that early treatment with angiotensin converting enzyme inhibitors improves clinical outcome. Based on these new results, the indication of perindopril has been extended to the reduction of cardiovascular risk in patients with stable coronary artery disease after myocardial infarction or revascularization.]

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