Document Detail

Risks and benefits of early treatment of acute myocardial infarction with an angiotensin-converting enzyme inhibitor in patients with a history of arterial hypertension: analysis of the GISSI-3 database.
MedLine Citation:
PMID:  12486426     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Many trials have proved the benefits of early systematic treatment with angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction (AMI). Pathophysiological studies, however, suggest potential harm in excessive reduction of blood pressure (BP) in hypertensive patients with ischemic heart disease. METHODS: We analyzed data from the GISSI-3 (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico) trial to assess the effects of early treatment with angiotensin-converting enzyme inhibitors during AMI in patients with a history of hypertension compared with normotensive patients. The trial randomly assigned 19,394 patients to 6 weeks of lisinopril treatment or control, starting treatment within 24 hours of AMI onset. RESULTS: In the 10,661 normotensive patients, lisinopril significantly reduced lethal events, but in the 7362 hypertensive patients, a higher rate of lethal events was reported the first day of treatment, and the benefits only appeared subsequently. These results may be attributable to the subgroup of 1165 hypertensive patients with low baseline systolic BP (lower quintile, BP <120 mm Hg), in whom critical hypotension was more prone to develop after lisinopril treatment. In fact, these patients showed a higher mortality rate as the result of an excess of cardiogenic shock during the first day of lisinopril treatment (odds ratio 3.07, 95% CI 1.39-6.77) and a persistent, unfavorable death trend after 6 weeks. CONCLUSIONS: These data suggest that caution should be exercised when using lisinopril in the acute phase of a myocardial infarction in patients with a history of hypertension but low systolic BP at presentation.
Fausto Avanzini; Gabriele Ferrario; Luigi Santoro; Paolo Peci; Paolo Giani; Eugenio Santoro; Maria Grazia Franzosi; Gianni Tognoni;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  144     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-12-17     Completed Date:  2003-01-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1018-25     Citation Subset:  AIM; IM    
Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche, Mario Negri, Milano, Italy.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Data Interpretation, Statistical
Hypertension / complications*
Hypotension / complications*
Lisinopril / therapeutic use*
Middle Aged
Myocardial Infarction / complications*,  drug therapy*
Randomized Controlled Trials as Topic
Survival Analysis
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 83915-83-7/Lisinopril

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