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ACE Inhibitor Controversies

Part of the Contemporary Cardiology book series (CONCARD)

Abstract

  • Angiotensin-converting enzyme (ACE) inhibitors have been shown in large randomized controlled trials (RCTs) to prevent cardiovascular disease (CVD) outcomes significantly in patients with hypertension and heart failure (HF) and in patients with acute myocardial infarction (MI) with left ventricular (LV) dysfunction. Several recent RCTs including Condesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) (1) and Valsartan in Acute Myocardial Infarction Trial (VALIANT) (2) have proved the equivalence of ACE inhibitors and angiotensin II receptor blockers (ARBs). Their adverse effects, however, deserve careful scrutiny if we are to give patients medications that have a lower adverse effect profile.

  • ACE inhibitors cause cough in more than 15 % of treated individuals and, most important, produce a significantly higher incidence of angioedema versus ARBs; this incidence is much higher in patients of African origin. Deaths owing to angioedema have been reported in several hypertension RCTs.

Keywords

Aldosterone Antagonist Prevent Heart Attack Trial Endpoint Reduction RAAS Blockade Preserve Left Ventricular Systolic Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Swedberg K, Granger CB, McMurray JJV, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:767–771.PubMedCrossRefGoogle Scholar
  2. 2.
    Pfeffer MA et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction or both. N Engl J Med 2003;349:1893–1906.PubMedCrossRefGoogle Scholar
  3. 3.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major out-comes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–2997.CrossRefGoogle Scholar
  4. 4.
    Casas JP, Chau W, Loukogeorgakis S, et al. Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: Systematic review and meta-analysis. Lancet 2005;366: 2026–2033.PubMedCrossRefGoogle Scholar
  5. 5.
    Dahlof B, Devereux RB, Kjeldsen SE, et al. for the LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint Reduction in Hypertension study (LIFE): A randomised trial against atenolol. Lancet 2002;359:995–1003.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindholm LH, Ibsen H, Borch-Johnsen K, et al. Risk of new-onset diabetes in the Losartan Intervention for Endpoint Reduction in Hypertension study. J Hypertens 2002;20:1879–1886.PubMedCrossRefGoogle Scholar
  7. 7.
    Julius S, Kjeldsen SE, Weber M, et al. for the VALUE Trial Group. Outcomes in hypertensive patients at high cardiovascular risk treated with regimes based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2002–2031.CrossRefGoogle Scholar
  8. 8.
    Pitt B, Zannad F, Remme WJ, et al. for the Randomized Evaluation Study Investigators. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999;341: 709.PubMedCrossRefGoogle Scholar
  9. 9.
    Pitt B, Remme W, Zannad F, et al. for the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309–1321.PubMedCrossRefGoogle Scholar
  10. 10.
    Al-Mallah MH, Tleyjeh IM, Abdel-Latif AA, et al. Angiotensin-converting enzyme inhibitors in coronary artery disease and preserved left ventricular systolic function. A systematic review and meta-analysis of randomized controlled trials. J Am Coll Cardiol 2006;47:1576–1583.PubMedCrossRefGoogle Scholar

Suggested Reading

  1. Jhund P, McMurray JJV. Does aspirin reduce the benefit of an angiotensin-converting enzyme inhibitor?: Choosing between the Scylla of observational studies and the Charybdis of subgroup analysis. Circulation 2006;113:2566–2568.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2007

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