title: Zofenopril and ramipril and acetylsalicylic acid in postmyocardial infarction patients with left ventricular systolic dysfunction: a retrospective analysis in hypertensive patients of the SMILE-4 study.
abstract: BACKGROUND
  Antecedent hypertension represents a risk factor for adverse outcomes in survivors of acute myocardial infarction (AMI). Prognosis of such patients might be greatly improved by drugs enhancing blood pressure control. In the present retrospective analysis of the randomized, double-blind, parallel-group, SMILE-4 study we compared the efficacy of zofenopril 60 mg and acetylsalicylic acid (ASA) 100 mg versus ramipril 10 mg and ASA in patients with AMI complicated by left ventricular dysfunction, classified according to a history of hypertension.
  
  
  METHODS
  The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. Hypertension was defined according to medical history and current blood pressure values at entry and could be determined in 682 of 716 patients of the intention-to-treat analysis.
  
  
  RESULTS
  One hundred and fifty-seven patients (23%) were normotensives and 525 (77%) hypertensives. In the normotensive population the primary end-point occurred in 19 of 76 zofenopril-treated patients (25%) and in 23 of 81 ramipril-treated patients (28%) [odds ratio (95% confidence interval): 0.84 (0.41-1.71), P = 0.631]. In the hypertensive population, major cardiovascular outcomes were reported in 84 of 273 zofenopril-treated patients (31%) and in 99 of 252 ramipril-treated patients (39%), with a 31% significantly (P = 0.041) lower risk with zofenopril [0.69 (0.48-0.99)]. The superiority of zofenopril versus ramipril was particularly evident in patients with isolated systolic hypertension [n = 131, 0.48 (0.23-0.99), P = 0.045].
  
  
  CONCLUSIONS
  This retrospective analysis of the SMILE-4 study confirmed the good efficacy of zofenopril and ASA in the prevention of long-term cardiovascular outcomes also in the subgroup of patients with hypertension.
authors.affiliation: Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Bologna. claudio.borghi@unibo.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
authors.forename: Stefano
authors.initials: S
authors.lastname: Omboni
authors.forename: Arrigo F G
authors.initials: AF
authors.lastname: Cicero
authors.forename: Stefano
authors.initials: S
authors.lastname: Bacchelli
authors.forename: Daniela D
authors.initials: DD
authors.lastname: Esposti
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.forename: Dario
authors.initials: D
authors.lastname: Zava
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002216:Captopril / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy / Q000401:mortality
chemical_list: D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; C044958:zofenopril; D002216:Captopril; D017257:Ramipril; D001241:Aspirin