Background Indications for angiotensin converting enzyme (ACE) inhibitors are well established. Clinical trials revealed good tolerability of ACE inhibitors in patients with acute myocardial infarction, but there are data showing that selected groups of patients may be at risk of hypotension after the first dose of ACE inhibitor. The aim of our study was to evaluate blood pressure profile in early treatment with ACE inhibitor - perindopril in hypertensive patients with acute myocardial infarction.
Material and methods The study was performed in 72 consecutive patients with acute myocardial infarction (AMI), from which were selected patients with a history of hypertension. In a group of 20 hypertensive patients in control group blood pressure monitoring was performed in 1 or 2, or 3rd day of AMI, day before the beginning of ACE inhibitor therapy. In a group of 12 patients with hypertension in history perindopril was given in 1 or 2, or 3rd day of AMI, and blood pressure monitoring was performed. Non-invasive 24-hour ambulatory blood pressure monitoring was programmed to measure blood pressure every 20 minutes during a day and every 30 minutes at night.
Results Mean 24-hours systolic blood pressure was significantly lower in a group of patients with acute myocardial infarction and hypertension history after the first dose of 4 mg of perindopril (121,5 ± 11,1 mm Hg vs. 111,5 ± 9,4 mm Hg, p < 0,02). There was also significantly lower day SBP (123,3 ± 11,5 mm Hg vs. 112,6 ± 9,2 mm Hg, p < 0,01) and night SBP (116,4 ± 12,5 mm Hg vs. 106,8 ± 8,5 mm Hg, p < 0,03) in a group of patients treated with perindopril. There was no significant difference in diastolic blood pressure and heart rate between control group and group of patients treated with perindopril. In the perindopril group, the maximum decrease of mean one hour SBP compared to the first mean one hour SBP occurred 9 hours after the dose (14,2 ± 3,7 mm Hg vs. 7,0 ± 3,3 mm Hg, p < 0,001, in perindopril and control group respectively). Similarly estimated decrease in DBP was also lower in the perindopril group (8,9 ± 8,7 mm Hg) in comparison to control group (3,5 ± 3,1 mm Hg) (p < 0,001).
Conclusions Perindopril may cause significant blood pressure decrease after the first dose in patients with acute myocardial infarction and with a history of hypertension.