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Even some with normal BP may benefit from ACE inhibitor
9 June 2009
MedWire News: Treatment based on an ACE inhibitor reduces the risk for death and major cardiovascular events across a broad spectrum of patients with cardiovascular disease, a meta-analysis of trials suggests.
Jasper Brugts (Erasmus University Medical Center, The Netherlands) and colleagues report benefits across a wide variety of baseline blood pressure (BP) levels.
“Therefore, the use of ACE inhibitors should be considered in all patients with established vascular disease or at high risk for vascular disease even in patients with normal BP levels,” they recommend.
The team conducted a combined analysis of 29,463 patients in the ADVANCE, EUROPA, and PROGRESS trials, who were randomly assigned to receive a perindopril-based regimen, which could include the diuretic indapamide, or placebo.
During a mean 4.0 years of follow-up, perindopril-based regimens were associated with a significant reduction in all-cause mortality (hazard ratio [HR]=0.89), cardiovascular mortality (HR=0.85), non-fatal myocardial infarction (MI, HR=0.80), stroke (HR=0.82), and heart failure admission (HR=0.84).
Results were consistent across subgroups with different clinical characteristics, concomitant medication use, and in all baseline BP strata.
A separate analysis of perindopril therapy in 14,779 patients that excluded indapamide use found the ACE inhibitor was no longer associated with a significant reduction in stroke, but resulted in a greater reduction in non-fatal MI (HR=0.76) and heart failure admissions (HR=0.71).
Reporting in the European Heart Journal, the researchers conclude: “These results support the provision of ACE-inhibitor-based treatment, not on the basis of arbitrary cut-off points for BP, but rather on the assessment of vascular risk, which is raised in patients with stable coronary artery disease, diabetes, and stroke.”
In an accompanying editorial, Bertram Pitt (University of Michigan School of Medicine, Ann Arbor, USA) added the results “should encourage greater use of proven ACE inhibitors at their target doses in patients with vascular disease independent of the occurrence of hypertension.”
