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ACE inhibitors captopril and enalapril induce regression of left ventricular hypertrophy in hypertensive patients with chronic renal failure.

https://arctichealth.org/en/permalink/ahliterature54522
Source
Nephrol Dial Transplant. 1997 May;12(5):945-51
Publication Type
Article
Date
May-1997
Author
A I Dyadyk
A E Bagriy
I A Lebed
N F Yarovaya
E V Schukina
G G Taradin
Author Affiliation
Department of Postgraduate Therapy Training, Medical University, Donetsk, Ukraine.
Source
Nephrol Dial Transplant. 1997 May;12(5):945-51
Date
May-1997
Language
English
Publication Type
Article
Keywords
Adult
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Blood Pressure - drug effects
Captopril - adverse effects - therapeutic use
Diastole - drug effects
Drug Tolerance
Enalapril - adverse effects - therapeutic use
Female
Hemodynamic Processes - drug effects
Humans
Hypertension - complications - drug therapy - physiopathology
Hypertrophy, Left Ventricular - complications - drug therapy - pathology
Kidney Failure, Chronic - complications
Male
Middle Aged
Prospective Studies
Single-Blind Method
Systole - drug effects
Ventricular Function, Left - drug effects
Abstract
BACKGROUND: Left ventricular hypertrophy is frequently noted in patients with moderate to severe chronic renal failure not requiring dialysis. Recently, several studies have shown reversal of myocardial hypertrophy in end-stage renal disease with long-term pharmacological control of blood pressure, but it is unclear whether left ventricular mass regresses or normalizes with antihypertensive treatment of patients with earlier stages of chronic renal failure. METHODS: Seventy-two undialysed patients with chronic renal failure, chronic mild-to-moderate hypertension, and left ventricular hypertrophy were randomly assigned in a prospective study to either the captopril (n = 36) or enalapril group (n = 36). Blood pressure measurements, echocardiographic and Doppler parameters were evaluated before treatment and at 6 and 12 months of therapy. RESULTS: During follow-up, six patients developed side-effects including dry cough, taste disturbances, skin rash and gastric intolerance. In the captopril group there was a decrease in mean left ventricular mass index by 12% after 6 months of treatment, which decreased by 20% after 12 months treatment. For enalapril, the average reduction of myocardial mass after 6 months treatment was 14% and after 12 months treatment, the decrease was 19%. In both treatment groups there was significant improvement of left ventricular filling dynamics. No deterioration of left ventricular systolic function was observed. CONCLUSIONS: Our results confirm that antihypertensive monotherapy with the ACE inhibitors, captopril and enalapril, in patients with chronic renal failure results in regression of left ventricular mass index associated with a significant improvement in the diastolic function of the left ventricle without a demonstrable deterioration in left ventricular systolic performance.
PubMed ID
9175047 View in PubMed
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[A comparison of the clinical efficacy of enalapril maleate analogs in patients with heart failure and ischemic heart disease]

https://arctichealth.org/en/permalink/ahliterature54339
Source
Eksp Klin Farmakol. 1998 Jul-Aug;61(4):20-2
Publication Type
Article
Author
V V Dunaev
A E Berezin
Author Affiliation
Department of Pharmacology, Zaporozhe State Medical University, Ukraine.
Source
Eksp Klin Farmakol. 1998 Jul-Aug;61(4):20-2
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Chronic Disease
Comparative Study
Drug Therapy, Combination
Echocardiography
Enalapril - adverse effects - analogs & derivatives - therapeutic use
English Abstract
Female
Heart Failure, Congestive - drug therapy - physiopathology - ultrasonography
Hemodynamic Processes - drug effects
Humans
Male
Middle Aged
Myocardial Ischemia - drug therapy - physiopathology - ultrasonography
Abstract
The authors examined 68 patients aged from 42 to 68 years with ischemic heart disease without a history of myocardial infarction and with angina pectoris of exertion functional class 2-3 and circulatory insufficiency class 2 (according to NYHA criteria). The criteria serving as the reason for relating patients to the follow-up group were left-ventricular end-diastolic volume > 160 ml, ejection fraction 0.55, threshold power of endured loads within a range of 71.5 +/- 2.30 watt. After stabilization of the clinical status by means of basic therapy (nitrates, blockers of slow calcium channels, diuretics, antiaggregants), all patients were divided into two follow-up groups. The first group consisted of 36 patients who received renitec (10 mg/24 h), patients of group 2 were given enap in the same dose. The course of treatment lasted 12 weeks. The effectiveness of treatment was controlled by echocardiography according to the standard methods in M- and B-regimens. Analysis of the obtained data showed that within 12-day follow-up renitec demonstrated higher effectiveness and lesser incidence of side-effects than did enap given in the same dose.
PubMed ID
9783102 View in PubMed
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Adequate clinical control of congenital nephrotic syndrome by enalapril.

https://arctichealth.org/en/permalink/ahliterature206000
Source
Pediatr Nephrol. 1998 Feb;12(2):130-2
Publication Type
Article
Date
Feb-1998
Author
S. Guez
M. Giani
M L Melzi
C. Antignac
B M Assael
Author Affiliation
Department of Pediatrics, University of Milan, Italy.
Source
Pediatr Nephrol. 1998 Feb;12(2):130-2
Date
Feb-1998
Language
English
Publication Type
Article
Keywords
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Child, Preschool
Enalapril - adverse effects - therapeutic use
Female
Finland
Follow-Up Studies
Haplotypes
Humans
Molecular Biology
Nephrotic Syndrome - congenital - drug therapy - genetics
Proteinuria - drug therapy
Abstract
The combination of captopril and indomethacin has been shown to control nephrotic proteinuria in an infant with congenital nephrotic syndrome of the Finnish type. We report the satisfactory control of congenital nephrotic syndrome by enalapril, maintaining normal serum albumin levels without albumin infusions. The haplotype data of our patient were consistent with the diagnosis of a Finnish-type nephrotic syndrome. After 21 months, during which daily infusions of albumin allowed partial control of the symptoms, captopril treatment was started. No adverse effects were noted. Serum creatinine levels remained normal. Within 8 weeks, albumin infusions were completely stopped. After 1 month the treatment was changed to a single dose of enalapril (0.8 mg/kg per day). During the next 15 months, the serum protein concentration was maintained around 6.5-7 g/dl, although proteinuria persisted (0.3-0.5 g/day). Weight and length gain are now satisfactory. We conclude that enalapril may be safely used in infants with severe forms of congenital nephrotic syndrome and might allow the avoidance of aggressive treatments for prolonged periods.
PubMed ID
9543371 View in PubMed
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Angio-oedema in relation to treatment with angiotensin converting enzyme inhibitors.

https://arctichealth.org/en/permalink/ahliterature73495
Source
BMJ. 1992 Apr 11;304(6832):941-6
Publication Type
Article
Date
Apr-11-1992
Author
T. Hedner
O. Samuelsson
H. Lunde
L. Lindholm
L. Andrén
B E Wiholm
Author Affiliation
Sahlgrenska University Hospital, Göteborg, Sweden.
Source
BMJ. 1992 Apr 11;304(6832):941-6
Date
Apr-11-1992
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioneurotic Edema - chemically induced
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Captopril - adverse effects
Enalapril - adverse effects
Female
Humans
Male
Middle Aged
Prognosis
Time Factors
Abstract
OBJECTIVE--To evaluate and describe the clinical course of angio-oedema reactions induced by angiotensin converting enzyme inhibitors. DESIGN AND METHODS--All reports of angio-oedema reactions associated with angiotensin converting enzyme inhibitors submitted to Swedish Adverse Reactions Advisory Committee were reviewed and the clinical courses summarised. Numbers of cases judged to be induced by angiotensin converting enzyme inhibitors were related to their annual usage, estimated from total sales of defined daily doses, as well as to the estimated number of new patients. All cases of angio-oedema associated with angiotensin converting enzyme inhibitors reported to the World Health Organisation's international drug information system were also summarised. RESULTS--36 of the 38 reported cases in Sweden between 1981 and 1990 were judged to be related to angiotensin converting enzyme inhibitors. During 1981 through 1990, altogether 1309 cases of angio-oedema associated with angiotensin converting enzyme inhibitors were registered with the international drug information system. The incidence of reported cases of angio-oedema increased largely in parallel with the increased sales (usage) of angiotensin converting enzyme inhibitors. Of the 36 Swedish patients, 77% experienced the reaction within the first three weeks after starting treatment. 10 patients needed hospitalisation, two of whom had life threatening laryngeal obstruction. With one exception all 36 patients were free of symptoms within one week after discontinuing the drug. CONCLUSIONS--Angio-oedema induced by angiotensin converting enzyme inhibitors is a rare but potentially life threatening reaction, which in most instances occurs shortly after the start of treatment. Any patient in whom the reaction is suspected should have the treatment interrupted and, if necessary, be admitted for observation.
Notes
Comment In: BMJ. 1992 Jul 18;305(6846):1831515849
Comment In: BMJ. 1992 May 30;304(6839):14431628033
PubMed ID
1581715 View in PubMed
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Antihypertensive drug classes and the risk of hip fracture: results from the Swedish primary care cardiovascular database.

https://arctichealth.org/en/permalink/ahliterature308808
Source
J Hypertens. 2020 01; 38(1):167-175
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2020
Author
Tove Bokrantz
Linus Schiöler
Kristina B Boström
Thomas Kahan
Dan Mellström
Charlotta Ljungman
Per Hjerpe
Jan Hasselström
Karin Manhem
Author Affiliation
Department of Molecular and Clinical Medicine, Institute of Medicine Institute of Medicine, Section of Occupational and Environmental Medicine Institute of Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg R&D Centre Primary Care, Skaraborg, Skövde Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm Centre for Bone Research at the Sahlgrenska Academy, Department of Internal Medicine and Geriatrics, University of Gothenburg, Gothenburg Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Stockholm, Sweden.
Source
J Hypertens. 2020 01; 38(1):167-175
Date
01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adrenergic beta-Antagonists - adverse effects - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Antihypertensive Agents - adverse effects - therapeutic use
Calcium Channel Blockers - adverse effects - therapeutic use
Hip Fractures - chemically induced - complications - epidemiology
Humans
Hypertension - complications - drug therapy - epidemiology
Primary Health Care
Risk factors
Sweden
Abstract
Hypertension and fractures related to osteoporosis are major public health problems that often coexist. This study examined the associations between exposure to different antihypertensive drug classes and the risk of hip fracture in hypertensive patients.
We included 59?246 individuals, 50 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of diagnosis of hypertension) until they had their first hip fracture, died, or reached the end of the study on 31 December 2012. Cox proportional hazards models were used to calculate the risk of hip fracture across types of antihypertensive medications, adjusted for age, sex, comorbidity, medications, and socioeconomic factors.
In total, 2593 hip fractures occurred. Compared to nonusers, current use of bendroflumethiazide or hydrochlorothiazide was associated with a reduced risk of hip fracture (hazard ratio 0.86; 95% CI 0.75-0.98 and hazard ratio 0.84; 95% CI 0.74-0.96, respectively), as was use of fixed drug combinations containing a thiazide (hazard ratio 0.69; 95% CI 0.57-0.83). Current use of loop diuretics was associated with an increased risk of hip fracture (hazard ratio 1.23; 95% CI 1.11-1.35). No significant associations were found between the risk of hip fracture and current exposure to beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone-receptor blockers or calcium channel blockers.
In this large observational study of hypertensive patients, the risk of hip fracture differed across users of different antihypertensive drugs, results that could have practical implications when choosing antihypertensive drug therapy.
Notes
CommentIn: MMW Fortschr Med. 2020 Aug;162(14):28 PMID 32780388
PubMed ID
31568060 View in PubMed
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Antihypertensive therapy and incidence of type 2 diabetes in an elderly cohort.

https://arctichealth.org/en/permalink/ahliterature178189
Source
Diabetes Care. 2004 Oct;27(10):2458-63
Publication Type
Article
Date
Oct-2004
Author
Raj Padwal
Muhammad Mamdani
David A Alter
Jan E Hux
Deanna M Rothwell
Karen Tu
Andreas Laupacis
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Diabetes Care. 2004 Oct;27(10):2458-63
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Antihypertensive Agents - adverse effects - therapeutic use
Benzothiadiazines
Calcium Channel Blockers - adverse effects - therapeutic use
Cohort Studies
Diabetes Mellitus, Type 2 - chemically induced - epidemiology
Diuretics
Female
Geriatric Assessment
Humans
Hypertension - diagnosis - drug therapy
Incidence
Male
Ontario - epidemiology
Probability
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk assessment
Sex Distribution
Sodium Chloride Symporter Inhibitors - adverse effects - therapeutic use
Abstract
The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes.
This was a retrospective, observational cohort study of previously untreated elderly patients (aged > or = 66 years) identified as new users of an antihypertensive drug class between April 1995 and March 2000. Using a Cox proportional hazards model, the primary analysis compared diabetes incidence in users of ACE inhibitors, beta-blockers, and calcium channel blockers (CCBs), with thiazide diuretics allowed as second-line therapy. In the secondary analysis, thiazide diuretics were added as a fourth study group.
In the multivariable-adjusted primary analysis (n = 76,176), neither ACE inhibitor use (hazard ratio 0.96 [95% CI 0.84-1.1]) nor beta-blocker use (0.86 [0.74-1.0]) was associated with a statistically significant difference in type 2 diabetes incidence compared with the CCB control group. In the secondary analysis (n = 100,653), compared with CCB users, type 2 diabetes incidence was not significantly different between users of ACE inhibitors (0.97 [0.83-1.1]), beta-blockers (0.84 [0.7-1.0]), or thiazide diuretics (1.0 [0.89-1.2]).
Type 2 diabetes incidence did not significantly differ among users of the major antihypertensive drug classes in this elderly, population-based administrative cohort. These results do not support the theory that different antihypertensive drug classes are relatively more or less likely to cause diabetes.
Notes
Comment In: Diabetes Care. 2005 Mar;28(3):762; author reply 762-315735235
PubMed ID
15451916 View in PubMed
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Atenolol as initial antihypertensive therapy: an observational study comparing first-line agents.

https://arctichealth.org/en/permalink/ahliterature163066
Source
J Hypertens. 2007 Jul;25(7):1499-505
Publication Type
Article
Date
Jul-2007
Author
David F Blackburn
Darcy A Lamb
Dean T Eurich
Jeffrey A Johnson
Thomas W Wilson
Roy T Dobson
James L Blackburn
Author Affiliation
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. d.blackburn@usask.ca
Source
J Hypertens. 2007 Jul;25(7):1499-505
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - adverse effects - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Antihypertensive Agents - adverse effects - therapeutic use
Atenolol - adverse effects - therapeutic use
Calcium Channel Blockers - adverse effects - therapeutic use
Canada - epidemiology
Cardiovascular Diseases - complications - mortality
Cohort Studies
Databases, Factual
Humans
Hypertension - complications - drug therapy - mortality
Odds Ratio
Retrospective Studies
Sodium Chloride Symporter Inhibitors - adverse effects - therapeutic use
Survival Rate
Abstract
The role of atenolol in the management of patients with hypertension is currently under scrutiny. Our aim was to evaluate the real-world consequences of recent clinical trial findings.
We conducted a retrospective, cohort study using linked administrative data from the province of Saskatchewan, Canada. Eligible subjects were first-ever users of antihypertensive medications between 1 January 1994 and 31 December 2003 and were grouped into four cohorts: atenolol, angiotensin-converting enzyme inhibitors (ACEI), thiazide diuretics, or calcium antagonists. Patients remained eligible during monotherapy only.
We identified 19 249 eligible individuals (mean age 60.6 years) who were followed for a mean of 2.3 years (SD 2.0). The rate of myocardial infarction, unstable angina, stroke, or death occurred in similar frequencies among all cohorts: atenolol (2.3%), ACEI (3.6%), thiazide diuretics (2.9%), and calcium antagonists (3.9%). After adjustment for potential confounders, atenolol therapy was not associated with higher event rates than the other first-line agents, with hazard ratios ranging between 1.03 [95% confidence intervals (CI) 0.72-1.46] and 1.24 (95% CI 0.91-1.68) for all cohorts compared with atenolol. Similar results were observed upon stratifying the sample into subjects above and below 60 years of age.
The low event rates for all cohorts suggest that atenolol has not been associated with a significant burden of cardiovascular morbidity or mortality in its traditional role for uncomplicated hypertension. Further study is needed to identify the specific types of patients that should avoid atenolol as an antihypertensive agent.
Notes
Comment In: J Hypertens. 2007 Jul;25(7):1351-317563554
PubMed ID
17563574 View in PubMed
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[Diabetes and COVID-19: analysis of the clinical outcomes according to the data of the russian diabetes registry].

https://arctichealth.org/en/permalink/ahliterature303953
Source
Probl Endokrinol (Mosk). 2020 08 04; 66(1):35-46
Publication Type
Journal Article
Date
08-04-2020
Author
Marina V Shestakova
Olga K Vikulova
Mikhail ? Isakov
Ivan I Dedov
Author Affiliation
Endocrinology Research Centre.
Source
Probl Endokrinol (Mosk). 2020 08 04; 66(1):35-46
Date
08-04-2020
Language
Russian
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Antihypertensive Agents - adverse effects - therapeutic use
COVID-19 - complications - drug therapy - mortality - virology
Diabetes Complications - drug therapy - mortality - virology
Diabetes Mellitus - drug therapy - mortality - virology
Diuretics - adverse effects - therapeutic use
Female
Humans
Hypertension - complications - drug therapy - mortality - virology
Insulin - metabolism
Male
Metformin - adverse effects - therapeutic use
Russia - epidemiology
SARS-CoV-2 - pathogenicity
Abstract
Data on the national level and worldwide show a higher rate of mortality in patients with diabetes mellitus (DM) due to COVID-19, which determines the high relevance of risk factor analysis for outcomes in DM patients to substantiate the strategy for this category of patients.
To assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI), glycemic control (HbA1c), and antidiabetic and antihypertensive drugs, including ACE inhibitors and ARBs) on clinical outcomes (recovery or death) in patients with type 2 DM.
A retrospective analysis of the Russian Register of Diabetes database was performed, including patients with type 2 DM (n=309) who suffered pneumonia/COVID-19 in the period from 01.02.2020 to 27.04.2020 and the indicated outcome of the disease (recovery or death) RESULTS: The percentage of lethality was determined to be 15.2% (47 of 309 people). The degree of lethality was found to be significantly higher in males (OR=2.08; 95% CI 1.1–3.9; p=0.022) and in patients on insulin therapy (OR=2.67; 95% CI; 1.42–5.02; p=0.002), while it was significantly lower in patients with an age <65 years (OR=0.34; 95% CI 0.18–0.67; p=0.001) and in patients receiving metformin (OR=0.26; 95% CI 0.14–0,5; p<0.0001), antihypertensive therapy (OR=0.43; 95% CI 0.22–0.82; p=0.009), β-blockers (OR=0.26; 95% CI 0.08–0.86; p=0.018), diuretics (OR=0.4; 95% CI 0.17–0.93; p=0.028) and renin-angiotensin system blockers (ACE inhibitors or ARBs) (OR=0.36; 95% CI 0.18–0.74; p=0.004). A tendency to an increase in lethality at higher rates of HbA1c and BMI was present, but it did not reach a statistical significance. Differences between patients receiving insulin therapy and those who were not receiving the insulin therapy were observed as follows: a significantly longer duration of type 2 DM (13.4 vs. 6.8 years, respectively; p<0.0001), worse overall glyacemic control (HbA1c: 8.1% vs. 7.0%, resp.; p<0.0001), and three times more frequent failure to achieve the HbA1c goal by more than 2.5% (14.7% vs. 5.9%, resp.; p=0.04).
The identified risk factors for lethality in patients with type 2 DM indicate that good glycemic control and previous treatment with metformin and antihypertensive drugs (including RAS blockers) could reduce the frequency of deaths. In patients on insulin therapy, a higher lethality degree was associated with worse glycemic control.
PubMed ID
33351311 View in PubMed
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Effectiveness of Fixed-Dose Perindopril/Amlodipine on Clinic, Ambulatory and Self-Monitored Blood Pressure and Blood Pressure Variability: An Open-Label, Non Comparative Study in the General Practice.

https://arctichealth.org/en/permalink/ahliterature276182
Source
High Blood Press Cardiovasc Prev. 2015 Dec;22(4):417-25
Publication Type
Article
Date
Dec-2015
Author
Yuri A Karpov
Vladimir M Gorbunov
Alexander D Deev
Source
High Blood Press Cardiovasc Prev. 2015 Dec;22(4):417-25
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Amlodipine - adverse effects - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Antihypertensive Agents - adverse effects - therapeutic use
Blood Pressure - drug effects
Blood Pressure Monitoring, Ambulatory
Calcium Channel Blockers - adverse effects - therapeutic use
Drug Combinations
Female
General practice
Humans
Hypertension - diagnosis - drug therapy - physiopathology
Male
Middle Aged
Observer Variation
Office Visits
Perindopril - adverse effects - therapeutic use
Predictive value of tests
Reproducibility of Results
Russia
Time Factors
Treatment Outcome
Abstract
Fixed-dose combinations (FDCs) of antihypertensive agents improve therapeutic efficacy, according to current guidelines and large clinical studies.
This Russian study examined the effect on blood pressure (BP) of substituting current ineffective antihypertensive treatment with FDC perindopril/amlodipine in patients with uncontrolled hypertension.
BP was measured in the doctor's office at each visit, daily at home, and by ambulatory monitoring (ABPM) at inclusion and end-of-study.
Ninety patients (52.7 ± 12.2 years old; mean baseline BP 161.4/94.9 mmHg) at high or very high cardiovascular risk were included. FDC perindopril/amlodipine (5/5, 10/5 or 10/10 mg) exerted a rapid (2 weeks) and significant (p
Notes
Comment In: High Blood Press Cardiovasc Prev. 2015 Dec;22(4):427-826359089
PubMed ID
26351011 View in PubMed
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Effect of ACE inhibitor trandolapril on life expectancy of patients with reduced left-ventricular function after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation.

https://arctichealth.org/en/permalink/ahliterature54222
Source
Lancet. 1999 Jul 3;354(9172):9-12
Publication Type
Article
Date
Jul-3-1999
Author
C. Torp-Pedersen
L. Køber
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. ctp@heart.dk
Source
Lancet. 1999 Jul 3;354(9172):9-12
Date
Jul-3-1999
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors - adverse effects - therapeutic use
Cause of Death
Comparative Study
Denmark
Double-Blind Method
Female
Follow-Up Studies
Humans
Indoles - adverse effects - therapeutic use
Life expectancy
Male
Middle Aged
Myocardial Infarction - drug therapy - mortality
Survival Rate
Treatment Outcome
Ventricular Dysfunction, Left - drug therapy - mortality
Ventricular Function, Left - drug effects
Abstract
BACKGROUND: The survival benefit from the use of inhibitors of angiotensin-converting enzyme (ACE) in patients with acute myocardial infarction is usually presented in terms of risk ratios and lives saved per 1000 people treated. A more relevant way to present the extent of benefit would be in terms of an increase in life expectancy, but this approach has not previously been possible because of limited data on long-term outcome. We aimed to calculate the effect of trandolapril on life expectancy with follow-up data from the Trandolapril Cardiac Evaluation (TRACE) Study. METHODS: The TRACE study previously showed a significant survival benefit with trandolapril in patients with reduced left-ventricular function after an acute myocardial infarction who were treated for at least 2 years. We ascertained the survival status of all patients in the TRACE study in June, 1998, at which time they had been followed up for a minimum of 6 years. We estimated life expectancy as median lifetime, which was the time for 50% of the patients to have died. Change in life expectancy is expressed as change in median lifetime. Analysis was by intention to treat. FINDINGS: The life expectancy of patients was 4.6 years for those given placebo versus 6.2 years for those on trandolapril. Thus, for patients on trandolapril, median lifetime was increased by 15.3 months or 27% (95% CI 7 to 51). Analysis of follow-up after the end of the study indicated no decrease of this benefit during the course of double-blind treatment; continued use of trandolapril was recommended at study closure. INTERPRETATION: In patients with severely reduced left-ventricular function, long-term treatment with an ACE inhibitor during the critical period after myocardial infarction is associated with a substantial increase in life expectancy.
Notes
Comment In: Lancet. 1999 Oct 30;354(9189):156410551537
Comment In: Lancet. 1999 Oct 9;354(9186):1301-210520662
PubMed ID
10406358 View in PubMed
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26 records – page 1 of 3.