Angiotensin-converting enzyme inhibitors myocardial infarction

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

Indications Hypertension, Myocardial Infarction Category Angiotensin-converting enzyme inhibitor Half-life 5.5 hours... 

ACC = American College of Cardiology ACE = angiotensin-converting enzyme Inhibitor AHA = American Heart Association AMI = acute myocardial Infarction CAD = coronary artery disease EF = ejection fraction IV = Intravenous CrcL = creatinine clearance SC = subcutaneous. 

K0ber L, Torp-Pedersen C, Carlsen JE, et al. A clinical trial of the Angiotensin-Converting-Enzyme Inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. The Trandolapril Cardiac Evaluation (TRACE) study group. N Engl J Med 1995 333(25) 1670—6. 

Captopril, an angiotensin-converting enzyme inhibitor (ACE), is indicated in the management of hypertension by itself or in combination with other antihypertensive medications, in heart failure when the patients have not responded adequately to digitalis, after myocardial infarction associated with left ventricular dysfunction, and in diabetic nephropathy (Figure 25). 

The MADIT II trial addressed some of the issues raised by the MADIT. The MADIT II trial evaluated patients with ischemic cardiomyopathy (history of myocardial infarction > 1 month before entry). New York Heart Association Functional Class I-III congestive heart failure, and left ventricular ejection fraction < 0.30 (documented within 3 months), with or without ventricular ectopy. The study enrolled 1,232 patients to assess if an ICD improve total mortality compared to optimal therapy alone. No Holter or electrophysiology test criteria were required for enrollment. Optimal medical therapy included angiotensin-converting-enzyme inhibitors, beta-blockers, diuretics, and lipidlowering statin drugs (172). 

Retrospective case-control studies reported that immediate-acting nifedipine increased the risk of myocardial infarction in patients with hypertension. Slow-release and long-acting vasoselective calcium channel blockers are usually well tolerated. Flowever, dihydropyridines, compared with angiotensin-converting enzyme (ACE) inhibitors, have been reported to increase the risk of adverse cardiac events in... 

Apart from the valuable benefit of aldosterone antagonism in hypertension, MR blockade has been shown to substantially reduce both morbidity and mortality among patients with severe chronic heart failure (CHF) and post-myocardial infarction (MI) in clinical trials [17, 18]. The Randomized Aldactone Evaluation Study (RALES) has shown that 26 mg spironolactone on average per day on top of existing standard therapy [i.e. an angiotensin-converting enzyme (ACE) inhibitor, aspirin and a loop diuretic] given to patients with severe heart failure (New York Heart Association class III or IV, left ventricular ejection fraction <35%) results in 30%... 

The angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor (AR) blockers are widely used for the treatment of hypertension, heart failure, and patients after myocardial infarction. There are currently at least 10 ACE inhibitors and 7 AR blockers marketed in the United States. 

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