Abstract
At present there is considerable activity in the area of prevention of atherosclerosis-related events using angiotensin-converting enzyme inhibitors. Large trials have demonstrated significant reduction in cardiovascular morbidity and mortality with long-term use of angiotensin-converting enzyme inhibitors in patients with left ventricular dysfunction, heart failure or acute myocardial infarction. Reductions in acute ischemic events (e.g., myocardial infarction, unstable angina and need for early revascularization) were independent of ejection fraction and were greater than would be expected from the small reduction in blood pressure that occurred, suggesting that other patients with coronary artery disease may benefit from angiotensin-converting enzyme inhibitor therapy. This hypothesis is being tested in multiple double-blind, randomized, controlled clinical trials with durations of follow-up of 3 to 5 years that will involve approximately 30,000 patients. The trials vary with respect to patient population (e.g., normotensive vs. hypertensive, normolipidemic vs. hyperlipidemic, with vs. without diabetes mellitus), angiotensin-converting enzyme inhibitor used and outcome measures. When available, the results of these clinical ...Continue Reading
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