Effects of the combination of candesartan plus captopril in elderly patients with anterior myocardial infarction - A pilot study

Objective: To verify the feasibility, tolerability and efficacy of the comb ination of, captopril (75 mg/day) and candesartan (8 mg/day) in early posti nfarction phases of not thrombolysed and unreperfused anterior acute myocar dial infarction (AMI) in elderly patients. Design and Patients: 71 patients (aged >65 years) hospitalised for anterior AMI were randomised in a double-blind manner into two groups: group A incl uded 35 patients who received captopril 75 mg/day within 3 days of admissio n plus candesartan 4mg, as a first dose, and 8 mg/day successively; group B included 36 patients who received captopril 75 mg/day and placebo. 90 days after admission, patients underwent echocardiography to determine end-syst olic volume (ESV) and ejection fraction (EF), end-diastolic diameter (EDD), E/A ratio, and E deceleration time. Results: Patients in both groups were similar with regard to age, gender, c reatine kinase peak, EF, ESV and risk factors. Six patients died during the trial and results reflect data from 65 patients who completed the 90-day s tudy period. Group A (captopril plus candesartan; n =32) patients showed a significant reduction in mean (SD) systolic blood pressure within the group (basal 138 +/- 16mm Hg); 10 days after admission 112 +/- 15mm Hg (p < 0.00 1), and in comparison with group B (captopril; n = 33) patients (basal 137 +/- 8 mm Hg); 10 days after admission 121 +/- 13mm Hg (intragroup p < 0.001 , between the two groups p = 0.009). Diastolic blood pressure was also lowe r in group A patients versus group B patients at 10 days after admission (7 1 +/- 12 vs 79 +/- 14mm HE; p = 0.012). At 90 days after admission, group A patients had a smaller ESV than patients in group B (56.5 +/- 10 vs 62. 3 +/- 11 ml/m(2); p = 0.03). The mitral E/A ratio was higher in group A than group B (0.71 +/- 0.16 ys 0.63 +/- 0.15; p = 0.042). In addition, group A s howed an increase of E/A ratio at 90 days after admission (p < 0.001). Ther e were no significant differences between the two groups in serum creatinin e, blood urea and serum potassium levels. Conclusion: The data suggest that the combination of captopril plus candesa rtan is feasible in the early treatment of AMI in elderly patients. and it appears that this combination has mure effect on ESV and E/A ratio, than ca ptopril alone in the short term.