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      Potential Proischemic Effect of Early Enalapril in Hypotension-Prone Patients with Acute Mγocardial Infarction

      ,

      Cardiology

      S. Karger AG

      ACE inhibition, Myocardial ischemia, Hypotension, Myocardial infarction

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          Abstract

          The objective of this study was to evaluate the relationship between early hemodynamic instability and myocardial ischemia and the effect of early intraveneous enalapril therapy on this relationship. In patients with myocardial infarction (MI), early treatment with angiotensin-converting enzyme inhibitors is controversial. In hypotensive patients, initiation of treatment may exacerbate myocardial ischemia and thereby affect the clinical outcome. Therefore, in the CONSENSUS II study, a total of 60 patients randomly allocated to either intravenous enalapril or placebo treatment commenced within 24 h after the onset of MI were evaluated by repeated blood pressure measurements, ambulatory ST-segment monitoring before discharge and exercise testing. Significant ST-depression was present in 34 patients. Patients with ST-depression before discharge (residual ischemia) during either exercise testing or ambulatory monitoring or both had a decrease in initial mean arterial blood pressure (MAP) of 20 vs. 9 mm Hg in those without ST-depression (n = 24), (p < 0.00001). However, patients (n = 13) with long-lasting ST-depression during Holter monitoring, ( > 60 min of ST-depression) presented with the most severe fall in MAP of 29 mm Hg (p < 0.00001) and a lower systolic blood pressure at inclusion (p < 0.01) compared to the remainder of patients. Furthermore, the number of recurrent acute ischemic events during follow-up was higher in these patients (7 vs. 1; p < 0.01). Ten of the patients treated with enalapril showed a long-lasting ST-depression versus only 3 in the placebo group (p = 0.08), and the average duration of all significant ST-depressions during Holter monitoring was significantly longer in the enalapril group compared to the placebo group (p < 0.05). Finally, 7 enalapril patients (20%) suffered an acute ischemic event in contrast to 1 patient (4%) in the placebo group (p = 0.07). In conclusion, early administration of enalapril had a potential proischemic effect in hypotension-prone patients mediated through exacerbation of the hemodynamic response, inasmuch as initial blood pressure fall after MI is related to residual myocardial ischemia and recurrent acute ischemic syndromes.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          0008-6312
          1421-9751
          1997
          1997
          19 November 2008
          : 88
          : 3
          : 285-291
          Affiliations
          Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
          Article
          177344 Cardiology 1997;88:285–291
          10.1159/000177344
          9129851
          © 1997 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Coronary Care

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