EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITION AFTER ACUTE MYOCARDIAL-INFARCTION IN PATIENTS WITH ARTERIAL-HYPERTENSION

Objective To evaluate the influence of a history of arterial hypertens ion on the efficacy of the angiotensin converting enzyme (ACE) inhibit or trandolapril in patients with acute myocardial infarction (AMI) and left ventricular dysfunction. Methods A retrospective analysis of dat a from the Trandolapril Cardiac Event (TRACE) study. The TRACE study w as a randomized, double-blind, placebo-controlled study in which patie nts with an enzyme-verified AMI and ejection fraction less than or equ al to 35% were assigned randomly to be administered oral trandolapril or placebo 3-7 days after the infarction. Of 1749 patients who entered the study, 400 (23%) had a history of arterial hypertension. The mean follow-up time was 26 months. Main outcome measures Mortality from an y cause. Secondary endpoints were sudden death, cardiovascular mortali ty, reinfarction and development of severe heart failure. Results Of t he patients in the hypertensive group, 173 (43%) died during follow-up , versus 500 (37%) in the normotensive group. Treatment with trandolap ril resulted in a relative risk of death from any cause for the hypert ensive group of 0.59 (95% confidence interval 0.44-0.80), versus 0.85 (0.72-1.02) for normotensive patients. In a multivariate analysis, tre atment with trandolapril was associated with a reduction in mortality among patients with a history of hypertension (P = 0.03). Conclusion I n this retrospective analysis, ACE inhibition after AMI complicated wi th left ventricular dysfunction was of greater benefit to patients wit h a history of arterial hypertension. ACE inhibition might be of parti cular importance in this group of patients but further studies to esta blish the clinical impact are necessary.