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Review: Angiotensin-converting enzyme inhibitors and coronary heart disease prevention

University of Nottingham Medical School, Derby City General Hospital, Uttoxeter Rd, Derby, DE22 3DT, richard.donnelly{at}nottingham.ac.uk

Gillian Manning

University of Nottingham Medical School, Derby City General Hospital, Uttoxeter Rd, Derby, DE22 3DT

A number of large randomised controlled trials have shown that angiotensin-converting enzyme (ACE) inhibitors, compared with placebo or other blood pressure-lowering drugs, improve coronary heart disease outcomes (fatal and non-fatal myocardial infarction, and coronary revascularisation) in diverse patient groups, e.g. in primary and secondary prevention, those with and without left ventricular dysfunction, and among hypertensive and non-hypertensive subjects. An updated meta-regression analysis which included five major trials in patients with established coronary artery disease (CAD) (EUROPA, INVEST, ACTION, PEACE and CAMELOT) concluded that ACE inhibitor (ACE-I) therapy has clear benefits in secondary prevention, but there are important and unexplained differences between trials in clinical outcome, baseline cardiovascular risk, blood pressure changes and trial design which deserve further discussion of the underlying mechanisms and clinical interpretation. For example, in placebo-controlled trials the biggest (20—22%) reductions in primary end points (including mortality) have been observed with perindopril and ramipril, whereas trials using trandolapril and quinapril had no effect on survival or recurrent CAD events. This review summarises and compares the major findings of these recent trials, and provides further analysis of the underlying mechanisms and clinical significance of secondary CAD prevention with ACE-I therapy.

Key Words: angiotensin-converting enzyme inhibitor • CHD • hypertension • angina • blood pressure reduction

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 8, No. 1, 13-22 (2007)
DOI: 10.3317/jraas.2007.002


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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 Donnelly, R. Articles by Manning, G. Search for Related Content PubMed PubMed Citation Articles by Donnelly, R. Articles by Manning, G. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Social Bookmarking                         What's this?