Beta-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists in treatment of elderly patients with acute myocardial infarction

Administration of beta-blockers reduces mortality among old persons during and after acute myocardial infarction, The American College of Cardiology/A merican Heart Association guidelines recommend that persons without contrai ndications to use of beta-blockers should be administered beta-blockers wit hin a few days of myocardial infarction (if administration is not initiated acutely) and that their administration should be continued indefinitely. T hese guidelines also recommend the use of angiotensin converting enzyme inh ibitors in treating persons within the first 24 h of suspected onset of acu te myocardial infarction with ST-segment elevation in two or more anterior precordial leads or with congestive heart failure in the absence of signifi cant hypotension or other contraindications to use of ACE inhibitors; and p ersons during and after convalescence from acute myocardial infarction with congestive heart failure associated with an abnormal left ventricular ejec tion fraction (LVEF) or with asymptomatic left ventricular systolic dysfunc tion with a LVEF < 40%. These guidelines state that there are no class 1 in dications for using calcium antagonists after myocardial infarction. If pat ients have persistent angina pectoris after myocardial infarction despite t reatment with beta-blockers and nitrates or hypertension inadequately contr olled by other drugs, administration of a nondihydropyridine calcium antago nist such as verapamil or diltiazem should be added to the therapeutic regi men if the LVEF is normal. If the LVEF is abnormal, administration of amlod ipine or felodipine should be added to the therapeutic regimen. Coron Arter y Dis 11:331-338 (C) 2000 Lippincott Williams & Wilkins.