24-hour blood pressure profile after the first dose of trandolapril in acute myocardial infarction

Abstract

Background Angiotensin converting enzyme (ACE) inhibitors became very effective therapeutic agents not only in hypertension, congestive heart failure but also in ischaemic heart disease. The use of ACE inhibitors in acute myocardial infarction (AMI) is based on their ability to limit ventricular enlargement and dysfunction. Early treatment with ACE inhibitors after AMI results in the reduction of mortality, morbidity and occurrence of cardiovascular events by attenuating process called remodelling. According to the results of long-term studies - the Survival and Ventricular Enlargement (SAVE), Acute Infarction Ramipril Efficacy (AIRE), Trandolapril Cardiac Evaluation (TRACE) and the fourth International Study of Infarct Survival (ISIS-4) the greatest benefit from ACE inhibitor therapy is in high risk patients such as significant left ventricular dysfunction (ejection fraction < 40%), anterior-wall infarction, heart failure, or a prior infarction. Safety profile of treatment with ACE inhibitors early in the course of acute myocardial infarction has not been established. According to some investigators incidence of severe hypotens'ton range from 21°fo to 50% in patients treated with ACE inhibitors early after acute myocardial infarction. Because potentially serious consequences of hypotension may occur it is very important to minimize the incidence of first dose hypotensive episodes by identifying and (if possible) correcting individual risk Factors. The object of our study was evaluation of the hypotensive effects of early treatment with ACE inhibitor - trandolapril in patients with acute myocardial infarction.
Methods The study was performed in 40 consecutive patients with acute myocardial infarction. On the third day of acute myocardial infarction studied group consisted of 16 patients (6 female, 10 male, age 61 ± 8 years, EF 51% ± 9%) received one dose of 2 mg of trandolapril per os. Control group, not treated with trandolapril, consisted of 24 patients with acute myocardial infarction (mean age 57 ± 10 years, EF 54 ± 9%). Non-invasive 24-h ambulatory blood pressure monitoring was performed by means of Spacelabs 90207 monitor. Patients were in the recumbent position for 24 hour. The monitor was programmed to measure blood pressure every 20 min during a day and every 30 min at night.
Results There was no significant diferences between studied and control group in the mean 24-h systolic (110 ± 15 mmHg us 118 ± 13 mmHg, p = 0.07), diastolic blood pressure (G7 ± 9 mmHg vs 71 ± 9 mmHg, p = 0.024) and heart rate (74 ± 11 bpm vs 75 t 11 bpm, p = 0.3). Mean day SBP (112 ± 15 mmHg vs 119 ± 14 mmHg, p = 0.1), mean day DBP (68 ± 9 mmHg vs72 ± 10 mmHg, p = 0.3) and mean dat HR (79 ± 12 bpm vs 77 ± 11 bpm, p = 0.6) did not show any significant diferences between study and control group Mean night SBP was lower in trandolapril treated group but diference was not significant (105 ± 15 mmHg vs 112 ± 12 mmHg, p= 0.08). There was significant diference of mean HR x SBP, for period between 4 and 20 hour after drug administration.
Conclusions We conclude that early treatment with ACE inhibitor-trandolapril, 2 mg dose, 72-h after acute myocardial infarction did not produce exacerbated hypotension.