Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction
There has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a first-line inhibitor of renin-angiotensin syst...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2023-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997890/?tool=EBI |
| _version_ | 1827992835867017216 |
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| author | Jae-Geun Lee Seung-Jae Joo Song-Yi Kim Joon-Hyouk Choi Ki Yung Boo Jin-Yong Hwang Seung-Ho Hur Myung Ho Jeong |
| author_facet | Jae-Geun Lee Seung-Jae Joo Song-Yi Kim Joon-Hyouk Choi Ki Yung Boo Jin-Yong Hwang Seung-Ho Hur Myung Ho Jeong |
| author_sort | Jae-Geun Lee |
| collection | DOAJ |
| description | There has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a first-line inhibitor of renin-angiotensin system (RASI) in patients with acute MI (AMI), but ARB is also frequently used to control blood pressure. This study investigated the association of ARB vs. ACEI with the long-term clinical outcomes in hypertensive patients with AMI. Among patients enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH, 4,827 hypertensive patients, who survived the initial attack and were taking ARB or ACEI at discharge, were selected for this study. ARB therapy was associated with higher incidence of 2-year major adverse cardiac events, cardiac death, all-cause death, MI than ACEI therapy in entire cohort. After propensity score-matching, ARB therapy was still associated with higher incidence of 2-year cardiac death (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20–2.14; P = 0.001), all-cause death (HR, 1.81; 95% CI, 1.44–2.28; P < 0.001), and MI (HR, 1.76; 95% CI, 1.25–2.46; P = 0.001) than the ACEI therapy. It was concluded that ARB therapy at discharge in hypertensive patients with AMI was inferior to ACEI therapy with regard to the incidence of CD, all-cause death, and MI at 2-year. These data suggested that ACEI be a more appropriate RASI than ARB to control BP in hypertensive patients with AMI. |
| first_indexed | 2024-04-10T04:14:27Z |
| format | Article |
| id | doaj.art-fb8be8c492f34fb0862de990e426ed8a |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-10T04:14:27Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fb8be8c492f34fb0862de990e426ed8a2023-03-12T05:32:30ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01183Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarctionJae-Geun LeeSeung-Jae JooSong-Yi KimJoon-Hyouk ChoiKi Yung BooJin-Yong HwangSeung-Ho HurMyung Ho JeongThere has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a first-line inhibitor of renin-angiotensin system (RASI) in patients with acute MI (AMI), but ARB is also frequently used to control blood pressure. This study investigated the association of ARB vs. ACEI with the long-term clinical outcomes in hypertensive patients with AMI. Among patients enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH, 4,827 hypertensive patients, who survived the initial attack and were taking ARB or ACEI at discharge, were selected for this study. ARB therapy was associated with higher incidence of 2-year major adverse cardiac events, cardiac death, all-cause death, MI than ACEI therapy in entire cohort. After propensity score-matching, ARB therapy was still associated with higher incidence of 2-year cardiac death (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20–2.14; P = 0.001), all-cause death (HR, 1.81; 95% CI, 1.44–2.28; P < 0.001), and MI (HR, 1.76; 95% CI, 1.25–2.46; P = 0.001) than the ACEI therapy. It was concluded that ARB therapy at discharge in hypertensive patients with AMI was inferior to ACEI therapy with regard to the incidence of CD, all-cause death, and MI at 2-year. These data suggested that ACEI be a more appropriate RASI than ARB to control BP in hypertensive patients with AMI.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997890/?tool=EBI |
| spellingShingle | Jae-Geun Lee Seung-Jae Joo Song-Yi Kim Joon-Hyouk Choi Ki Yung Boo Jin-Yong Hwang Seung-Ho Hur Myung Ho Jeong Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction PLoS ONE |
| title | Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| title_full | Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| title_fullStr | Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| title_full_unstemmed | Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| title_short | Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| title_sort | impact of angiotensin converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997890/?tool=EBI |
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