title: Additive effects of β-blockers on renin-angiotensin system inhibitors for patients after acute myocardial infarction treated with primary coronary revascularization.
abstract: BACKGROUND
  Although some β-blockers are effective for patients after acute myocardial infarction (AMI), few studies have compared their additive effects on renin-angiotensin system inhibitors (RAS-Is).
  
  
  RESULTS
  The 251 consecutive AMI patients administered angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin-II receptor blockers (ARBs) were retrospectively investigated and divided into 2 groups: treated without β-blockers (no-β-blocker group, n=80) or treated with β-blockers before discharge (β-blocker group, n=171; carvedilol [n=91] or bisoprolol [n=80]). The doses of RAS-Is used for patients in the no-β-blocker group were at least double those used in the β-blocker group. No significant differences between the 2 groups were observed with regard to baseline characteristics. After a 12-month follow-up, the survival and cardiac event-free rates in the β-blocker group were significantly higher than those in the no-β-blocker group. The percent change in blood pressure did not significantly differ between the 2 groups, but the levels of brain natriuretic peptide, metalloproteinase-2, and metalloproteinase-9 and the left ventricular ejection fraction improved significantly in the β-blocker group compared with the no-β-blocker group. Regarding the 2 β-blockers, carvedilol treatment produced more favorable outcomes than bisoprolol.
  
  
  CONCLUSIONS
  The data suggest that treatment with RAS-I in combination with β-blocker is more effective for patients after AMI than treatment with RAS-I alone.
authors.affiliation: Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Konishi
authors.forename: Go
authors.initials: G
authors.lastname: Haraguchi
authors.forename: Shunji
authors.initials: S
authors.lastname: Yoshikawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inagaki
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D017298:Bisoprolol / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002227:Carbazoles / Q000008:administration & dosage*; D000077261:Carvedilol; D004357:Drug Synergism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011412:Propanolamines / Q000008:administration & dosage*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D017298:Bisoprolol