Does the addition of losartan improve the beneficial effects of ACE inhibitors in patients with anterior myocardial infarction? A pilot study

Objective-To verify the efficacy of the combination of captopril (75 mg day ) and losartan (25 mg/day) in early postinfarction phases of reperfused ant erior acute myocardial infarction. Design and patients-99 patients, hospitalised for suspected anterior acute myocardial infarction within four hours from the onset of symptoms, were ra ndomised into two groups: group A included 50 patients who received captopr il 75 mg/day and placebo; group B included 49 patients who received captopr il 75 mg/day within three days of admission plus losartan 12.5 mg, as a fir st dose, and 25 mg/day successively. An additional 23 patients with anterio r acute myocardial infarction received losartan 25 mg alone and acted as co ntrols (group C) to check the effects of losartan on plasma angiotensin II (AII) concentrations. Noradrenaline (norepinephrine) (NA) and All plasma co ncentrations were measured on the third and 10th day after admission in 93 patients (35 from group A, 35 from group B, and 23 from group C). 90 days a fter admission patients underwent echocardiography to determine end systoli c volume (ESV) and ejection fraction (EF). Results-Patients in groups A and B were similar with regard to age, sex, cr eatine kinase peak, EF, ESV: and risk factors. Group B (captopril plus losa rtan) patients showed a significant reduction in mean (SD) systolic blood p ressure within the group (basal 128 (10) mm Hg; 10 days after admission 105 (9) mm Hg, p < 0.001), and in comparison with group A (captopril) patients (basal 127 (11) mm Hg; 10 days after admission 116 (10) mm Hg, p < 0.001). Diastolic blood pressure was also lower in group B patients versus group A (66 (11) v 77 (11) mm Hg). Group C (losartan) patients also showed a signi ficant reduction in systolic blood pressure (131 (13) mm Hg down to 121 (12 ) mm Hg, p < 0.001). Neither NA nor AII plasma concentrations in groups A a nd B differed significantly in basal samples (NA 673 (138) v 675 (141) pg/m l; AII 12.77 (4.79) v 12.65 (4.71) pg/ml) or 10 days after admission (NA 28 3 (93) v 277 (98) pg/ml; All 5.31 (2.25) v 6.09 (3.31) pg/mg). However, pat ients in group C had higher plasma concentrations of AII (14.79 (5.7) pg/ml on the third day and 7.98 (4.92) pg/ml on the 10th day) than patients in e ither group A or B (p = 0.006). After 90 days following treatment, group B (captopril plus losartan) patients had a smaller ESV than patients in group A (captopril) and group C (losartan). Conclusion-The data suggest that the combination of captopril plus losartan is feasible in the early treatment of acute myocardial infarction patients , and it appears that this combination has more effect on ESV than captopri l alone in the short term.