title: Comparison of perindopril versus captopril for treatment of acute myocardial infarction.
abstract: Angiotensin-converting enzyme (ACE) inhibitors reduce mortality in patients with acute myocardial infarction (AMI), but these benefits might be limited by acute hemodynamic changes and difficulties in titrating to recommended doses. The objective of this study was to compare the hemodynamic changes and tolerability of perindopril with captopril after AMI. We randomized 212 patients to receive either captopril (n = 102) or perindopril (n = 110) within 72 hours of AMI. Captopril was given as an initial dose of 6.25 mg, and then 50 mg/day on day 1 and 100 mg/day thereafter. The corresponding doses of perindopril were 2, 4, and 8 mg/day. Acute hemodynamic changes, the percentage of patients who reached target doses, and in-hospital and 6-month cardiovascular events were monitored. Baseline clinical characteristics of the 2 groups were identical, but patients randomized to perindopril were in a higher Killip class (1.4 +/- 0.6 vs 1.2 +/- 0.5, p = 0.05). During the first 6 hours, treatment with perindopril resulted in higher minimal systolic (97 +/- 15 vs 91 +/- 14 mm Hg, p <0.01) and diastolic blood pressure (BP) (57 +/- 11 vs 54 +/- 10 mm Hg, p <0.02), later occurrence of minimal BP (3.6 +/- 0.2 vs 2.7 +/- 0.1 hour, p <0.001), and a lower incidence of persistent hypotension with systolic BP < 90 mm Hg for > or =1 hour (5% vs 16%; p < 0.01) compared with captopril. At initial administration, target doses of perindopril and captopril were attained in 97% and 82% of the patients, respectively (p < 0.01). After 6 months, there were no differences between patients treated with perindopril and captopril in mortality rates (6% vs 13%, p = 0.16) and need for revascularization (20% vs 21%, p = 0.9). Thus, in patients during AMI, perindopril treatment showed better short-term tolerance than treatment with captopril, with significantly less acute hemodynamic changes and fewer withdrawals.
authors.affiliation: Queen Mary Hospital, Hong Kong, China. cplau@hkucc.hku.hk
authors.forename: Chu Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Hung Fat
authors.initials: HF
authors.lastname: Tse
authors.forename: William
authors.initials: W
authors.lastname: Ng
authors.forename: Kwok Keung
authors.initials: KK
authors.lastname: Chan
authors.forename: Shu Kin
authors.initials: SK
authors.lastname: Li
authors.forename: Kin Kwan
authors.initials: KK
authors.lastname: Keung
authors.forename: Yuk Kong
authors.initials: YK
authors.lastname: Lau
authors.forename: Wai Hong
authors.initials: WH
authors.lastname: Chen
authors.forename: Yuen Wai
authors.initials: YW
authors.lastname: Tang
authors.forename: Sum Kin
authors.initials: SK
authors.lastname: Leung
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D020913:Perindopril / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril; D020913:Perindopril