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Different angiotensin‐converting enzyme inhibitors have similar clinical efficacy after myocardial infarction
Author(s) -
Hansen Morten L.,
Gislason Gunnar H.,
Køber Lars,
Schramm Tina Ken,
Folke Fredrik,
Buch Pernille,
Abildstrom Steen Z.,
Madsen Mette,
Rasmussen Søren,
TorpPedersen Christian
Publication year - 2008
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2007.02991.x
Subject(s) - medicine , captopril , ramipril , trandolapril , enalapril , ace inhibitor , angiotensin converting enzyme , myocardial infarction , perindopril , hazard ratio , proportional hazards model , cardiology , confidence interval , pharmacology , blood pressure
What is already known about this subject • Treatment with an angiotensin‐converting enzyme (ACE) inhibitor benefits many patients with cardiovascular disease. • ACE inhibitors are generally assumed to be equally effective, but this has never been fully verified in clinical trials. What this study adds • Studying the association among ACE inhibitors after myocardial infarction demonstrated similarity in clinical outcome and supports a dosage–response relationship. • Therefore, for long‐term benefits for patients who need treatment with an ACE inhibitor, a focus of treatment at the recommended dosage is most important and not which ACE inhibitor is used. Aim Therapy with angiotensin‐converting enzyme (ACE) inhibitors is common after myocardial infarction (MI). Given the lack of randomized trials comparing different ACE inhibitors, the association among ACE inhibitors after MI in risk for mortality and reinfarction was studied. Methods Patients hospitalized with first‐time MI ( n = 16 068) between 1995 and 2002, who survived at least 30 days after discharge and claimed at least one prescription of ACE inhibitor, were identified using nationwide administrative registries in Denmark. Results Adjusted Cox regression analysis demonstrated no differences in risk for all‐cause mortality, but patients using captopril had higher risk of reinfarction (hazard ratio 1.18, 95% confidence interval 1.05, 1.34). However, following adjustment for differences in used dosages, all ACE inhibitors had similar clinical efficacy. Risk of all‐cause mortality: trandolapril (reference) 1.00, ramipril 0.97 (0.89, 1.05), enalapril 1.04 (0.95, 1.150), captopril 0.95 (0.83, 1.08), perindopril 0.98 (0.84, 1.15) and other ACE inhibitors or angiotensin II receptor blockers (ARB) 1.06 (0.94, 1.19). Reinfarction: trandolapril (reference) 1.00, ramipril 0.98 (0.89, 1.08), enalapril 1.04 (0.92, 1.17), captopril 1.05 (0.89, 1.25), perindopril 0.96 (0.81, 1.14) and other ACE inhibitors or ARB 0.99 (0.86, 1.14). Furthermore, the association between ARBs and clinical events was similar to ACE inhibitors (trandolapril reference): all‐cause mortality 0.99 (0.84, 1.16) and recurrent MI 0.99 (0.83, 1.19). Conclusions Our results suggest a class effect among ACE inhibitors when used in comparable dosages. Focus on treatment at the recommended dosage is therefore most important, and not which ACE inhibitor is used.