ACE Inhibitors, Coronary Heart Disease, and Atherosis

An influential proposal came out of a retrospective review of 219 dossiers of hypertensive patients by Brunner et al. (324). They con- 

As for hypertension, congestive heart failure, and myocardial infarction, there are physiological and pharmacological rationales for the use of ACE inhibitors in patients with asymptomatic and symptomatic (angina pectoris) coronary heart disease. 

The main argument in favor of a beneficial effect of ACE inhibition on coronary heart diseases comes from the pooled results of the SOLVE) treatment trial, the SOLVE) prevention trial, and the SAVE, AIRE, and TRACE studies, which indicate a 21% (95% Cl, 11-29%, p . 001) relative risk reduction for myocardial infarction associated with ACE inhibitor therapy. Enalapril (SOLVE)) significantly reduced hospitalization for unstable angina, and captopril (SAVE) reduced revascularization procedures (291). In patients treated for 38 to 42 months with enalapril or captopril and selected on the basis of a reduction in ejection fraction with or without heart failure, it is necessary to treat 49 patients to avoid one myocardial infarction (95% Cl 32-117). 

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