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Effect of angiotensin converting enzyme inhibition after acute myocardial infarction in patients with arterial hypertension

Gustafsson, Finn1,3; Torp-Pedersen, Christian2; Køber, Lars2; Hildebrandt, Per1; on behalf of the TRACE study group

Original article

Objective: To evaluate the influence of a history of arterial hypertension on the efficacy of the angiotensin converting enzyme (ACE) inhibitor trandolapril in patients with acute myocardial infarction (AMI) and left ventricular dysfunction.

Methods: A retrospective analysis of data from the Trandolapril Cardiac Event (TRACE) study. The TRACE study was a randomized, double-blind, placebo-controlled study in which patients with an enzyme-verified AMI and ejection fraction ≤ 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 any cause. Secondary endpoints were sudden death, cardiovascular mortality, reinfarction and development of severe heart failure.

Results: Of the patients in the hypertensive group, 173 (43%) died during follow-up, versus 500 (37%) in the normotensive group. Treatment with trandolapril resulted in a relative risk of death from any cause for the hypertensive 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, treatment with trandolapril was associated with a reduction in mortality among patients with a history of hypertension (P = 0.03).

Conclusion: In this retrospective analysis, ACE inhibition after AMI complicated with left ventricular dysfunction was of greater benefit to patients with a history of arterial hypertension. ACE inhibition might be of particular importance in this group of patients but further studies to establish the clinical impact are necessary.

1From the Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Denmark

2Department of Cardiology, Gentofte University Hospital, Denmark.

3Requests for reprints to Dr Finn Gustafsson, Department of Medical Physiology, The Panum Institute 10.5, DK-2000, Copenhagen, Denmark.

Sponsorship: The TRACE study was sponsored by Knoll AG and Roussel Uclaf.

Received 27 November 1996 Revised 12 March 1997 Accepted 20 March 1997

© Lippincott-Raven Publishers.