ANGIOTENSIN RECEPTOR BLOCKERS VS ANGIOTENSIN-CONVERTING ENZYME INHIBITORS IN HYPERTENSIVE PATIENTS WITH SYSTOLIC DYSFUNCTION AFTER MYOCARDIAL INFARCTION

OBJECTIVE:Current guidelines recommend angiotensin-converting enzyme inhibitor (ACEi) as a first-line blocker of renin-angiotensin system after myocardial infarction (MI), especially in patients with decreased systolic function, but angiotension receptor blockers (ARB) is also frequently used to con...

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Published in:	Journal of hypertension Vol. 37 Suppl 1; p. e82
Main Authors:	Joo, S, Lee, J.-G, Beom, J.W, Choi, J.-H, Kim, S.-Y, Kim, K.-S, Rha, S.W, Jeong, J.-O, Chae, S.C, Choi, D.-J, Park, J.S, Jeong, M.H
Format:	Journal Article
Language:	English
Published:	Copyright Wolters Kluwer Health, Inc. All rights reserved 01-07-2019
Online Access:	Get full text
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Summary:	OBJECTIVE:Current guidelines recommend angiotensin-converting enzyme inhibitor (ACEi) as a first-line blocker of renin-angiotensin system after myocardial infarction (MI), especially in patients with decreased systolic function, but angiotension receptor blockers (ARB) is also frequently used to control blood pressure in hypertensive patients with MI. This study aimed to investigate the long-term clinical effects of ARB in hypertensive patients with acute MI who survived the initial attack. DESIGN AND METHOD:Among 13,104 patients who enrolled in nationwide acute MI database of South Korea, the KAMIR-NIH Registry, 3,970 hypertensive patients, who survived the initial attack and were taking ARB or ACEi at the time of discharge, were selected after propensity score matching (1,985 patients in each group). RESULTS:Compared with ACEi, ARB increased 1-year MI (3.6 ± 0.5% vs. 1.9 ± 0.3%; p = 0.006) on Kaplan-Meier analysis. Multivariate Cox-proportional hazard analysis including age, gender, diabetes mellitus, previous history of angina, MI or heart failure, smoking, body mass index, Killip class, decreased renal function, left ventricular ejection fraction (LVEF), type of MI, and beta-blockers as co-variates, also showed that ARB was a significant risk factor for recurrent MI (HR; 1.74, 95% CI; 1.15–2.64; p = 0.009). However, there was a significant subgroup interaction according to LVEF. In patients with LVEF < 50%, ARB increased 1-year MI (6.0 ± 1.1% vs. 1.7 ± 0.5%; p = 0.001) with HR of 3.25 (95% CI; 1.54–6.85; p = 0.002). In patients with LVEF >= 50%, ARB showed a comparable 1-year MI rate with ACEi (2.5 ± 0.4% vs. 2.1 ± 0.4%; p = 0.537). *HR; hazard ratio, CI; confidence interval CONCLUSIONS:ARB, compared with ACEi, increased the recurrent MI in hypertensive patients with decreased LV systolic function after MI. ACEi may be a more appropriate blocker of renin-angiotensin system to control blood pressure in patients with MI.(Figure is included in full-text article.)
ISSN:	0263-6352 1473-5598
DOI:	10.1097/01.hjh.0000571188.83601.16