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Will more complete inhibition of the RAAS with angiotensin receptor blockade improve survival following myocardial infarction?

Harvard Medical School, Cardiovascular Division, Brigham and Women's Hospital, Boston, USA, mpfeffer@ rics.bwh.harvard.edu

Angiotensin-converting enzyme (ACE) inhibitors have a well-established role in the management of patients with hypertension, diabetes, heart failure and myocardial infarction (MI). ACE inhibitors have been particularly well studied in acute and chronic MI with consistent and substantial survival benefits demonstrated, particularly in the higher risk groups. The recent development of angiotensin II (Ang II) receptor blockers (ARBs) as a well tolerated pharmacological therapy to more completely inhibit the actions of Ang II at the AT₁-receptor level raises questions concerning comparative efficacy with the proven ACE inhibitor experience. Two major trials will provide a direct comparison of ARBs with an ACE inhibitor. The Valsartan in Acute Myocardial Infarction (VALIANT) trial is specifically designed to compare and contrast the ARB, valsartan, used both alone as well as in combination with a proven ACE inhibitor regimen, in a high risk MI population. VALIANT, with its three arms targetting 14,500 patients, is uniquely poised to determine whether the pharmacological advance in the development of ARBs confers additional clinical (survival) value in high risk MI patients.

Key Words: angiotensin II receptor blocker • myocardial infarction • long-term trial • valsartan • OPTIMAAL • VALIANT

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 1, No. 2 suppl, S41-S43 (2000)
DOI: 10.3317/jraas.2000.056


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pfeffer, M. A Search for Related Content PubMed PubMed Citation Articles by Pfeffer, M. A Social Bookmarking                         What's this?