title: Efficacy and safety of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and hyponatremia.
abstract: BACKGROUND
  The presence of hyponatremia has been perceived to increase the risk of adverse events on initiation of treatment with angiotensin-converting enzyme inhibition in heart failure patients. The aim of this study was to investigate if baseline hyponatremia (plasma Na(+) <135 mmol/L) predicts development of hypotension and renal impairment in patients with myocardial infarction (MI) and left ventricular dysfunction (LVD) treated with angiotensin-converting enzyme inhibitors.
  
  
  RESULTS
  A retrospective analysis was performed with data from the Trandolapril Cardiac Evaluation (TRACE) a double-blind randomized study. Plasma sodium levels were available in 1,731 patients, who were considered as the study population. Patients 3-7 days after MI with left LVD (LVEF ≤0.35), were randomized to trandolapril (n = 876) or placebo (n = 873). Baseline hyponatremia did not predict development of hypotension or worsening renal function after 1 month in patients treated with trandolapril compared with placebo (122 ± 19.1 mm Hg vs 123.2 ± 20.4 mm Hg [P = .84]; and creatinine clearance 57.4 ± 21.4 mL/min vs 55.2 ± 21.0 mL/min [P = .8]). There was no interaction between hyponatremia and the effect of trandolapril (P = .68).
  
  
  CONCLUSIONS
  Mild hyponatremia was not a contraindication for the initiation of treatment with angiotensin-converting enzyme inhibitors in patients with post-MI heart failure.
authors.affiliation: Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: louise.balling@gmail.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Balling
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000188:drug therapy* / Q000401:mortality*; D007022:Hypotension / Q000139:chemically induced / Q000175:diagnosis; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007211:Indoles; C052035:trandolapril
keywords: ACE-I; heart failure; hyponatremia