Overview of randomised trials of ACE inhibitors.

摘要

Angiotensin-converting-enzyme (ACE) inhibitors have the broadest effect of any drug in cardiovascular medicine, reducing the risk of death, myocardial infarction, stroke, diabetes, and renal impairment. They benefit patients with heart failure or left ventricular dysfunction, and patients after myocardial infarction or with peripheral vascular disease, diabetes, stroke, or transient ischaemic attack. Furthermore, ACE inhibitors slow or prevent the progression to end-stage renal disease in patients with diabetic5 and non-diabetic chronic nephropathies, and reduce the risk of nephropathy in those with diabetes and no evidence of renal disease.7A recent meta-analysis of six randomised trials, including 33500 patients with coronary artery disease and preserved left ventricular systolic function, showed that ACE inhibitors significantly reduced mortality and cardiovascular events. In today's Lancet, Gilles Dagenais and colleagues reportsimilar results in an overview ofthree large trials of these drugs in patients with atherosclerosis and no evidence of heart failure or left ventricular dysfunction. The trials were: the Heart Outcomes Prevention Evaluation (HOPE), the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA), and the Prevention of Events with Angiotensin-Converting-Enzyme inhibition trial (PEACE). The data showed a benefit of ACE inhibitors in patients with annual major vascular event rates "across a broad range of risk for cardiovascular events varying between as high as 10% per year to as low as 1.7%". The researchers concluded that "the use ACE inhibitors should be considered in all patients with vascular disease as long as they can tolerate these agents".