Avanzini F, Santoro L, Ferrario G, Peci P, Giani P
Early treatment with lisinopril after acute myocardial
infarction: Are risks greter than benefits in hypertensives?
Results of the GISSI-3 database
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:80A 1997
The authors propose that excessive BP reduction (after an acute MI ?), may
be harmful in patients with EH. Therefore, they conducted a retrospective
analysis of the data from 19,294 patients in the "GISSI-3 year study"
where 39 % of cases had EH.
Patients were randomly assigned to either lisinopril ( L= 3,720 EH, and
5,297 NT), or no L ( 3,642 EH and 5,364 NT). The results (See original
Table) shows the mortality for days 0-1, 2-42, and 0-42. Mortality was
higher for hypertensives, as expected, in all study periods, regardless of
L treatment. For days 0-2, mortality was 2 % for EH and 1.8 % for NT and
= 1.12 (0.8 1.58), significance not given. On the other hand mortality
was reduced by L treatment from 7.6 % to 6.7 % and O.R. = 0.89 (0.74
1.07), for days 2-42. The authors conclude that L is less effective after
acute MI in patients with a history of EH, because of lack of benefit in
the first 2 days, and the possible risk of hypotension.
Comment: One can also conclude that except for the first day results
,
lisinopril was effective in reducing mortality at all other time periods
after an MI. The view that ACE inhibitors offer protection in this
setting is also supported by a similar abstract by
Gustafsson et
al from
Denmark.
(Armando Lindner, M.D., University of Washington, Seattle)
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12th Annual ASH Meeting
H: Drug therapy :
ACE inhibitors
H: Pathophysiology :
Heart in hypertension