INFLUENCE OF A HISTORY OF ARTERIAL-HYPERTENSION AND PRETREATMENT BLOOD-PRESSURE ON THE EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION AFTER ACUTE MYOCARDIAL-INFARCTION

Objective To evaluate the influence of a history of arterial hypertens ion and the level of pretreatment blood pressure on the efficacy of th e angiotensin converting enzyme (ACE) inhibitor trandolapril on mortal ity and morbidity in patients with acute myocardial infarction (AMI) a nd left ventricular dysfunction.Methods Data from the Trandolapril Car diac Event study, in which 1749 patients with an enzyme verified AMI a nd echocardiographic evidence of left ventricular dysfunction were ran domized in a double-blind manner to treatment with trandolapril or pla cebo, were retrospectively analysed. Follow up time was 24-50 months ( mean 26 months). Results Four hundred patients (23%) had a history of arterial hypertension. A total of 173 (43%) patients with a history of hypertension died during follow up versus 500 (37%) patients in the n ormotensive group. Treatment with trandolapril in the hypertensive ind ividuals was associated with a reduction in the relative risk of death to 0.59 (95% confidence interval 0.44-0.80), versus 0.85 (0.72-1.02) in the normotensive individuals. The significant reduction in mortalit y in hypertensive individuals persisted after multivariate analysis co ntrolling for a broad spectrum of potential confounders. Also, benefit from ACE inhibition increased with increasing blood pressure at the t ime of randomization. Significant interactions between benefit from AC E inhibition and hypertension history, and systolic and diastolic bloo d pressure were found. Conclusion ACE inhibition after AMI complicated by left ventricular dysfunction may be of particular importance in pa tients with a history of arterial hypertension or a relatively high pr etreatment blood pressure. However, further investigations are necessa ry to establish the clinical impact of these results. (C) 1998 Rapid S cience Ltd.