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Titolo:
Does the addition of losartan improve the beneficial effects of ACE inhibitors in patients with anterior myocardial infarction? A pilot study
Autore:
Di Pasquale, P; Bucca, V; Scalzo, S; Cannizzaro, S; Giubilato, A; Paterna, S;
Indirizzi:
GF Ingrassia Hosp, Div Cardiol Paolo Borsellino, I-90144 Palermo, Italy GFIngrassia Hosp Palermo Italy I-90144 rsellino, I-90144 Palermo, Italy Univ Palermo, Dept Internal Med, I-90133 Palermo, Italy Univ Palermo Palermo Italy I-90133 Internal Med, I-90133 Palermo, Italy
Titolo Testata:
HEART
fascicolo: 6, volume: 81, anno: 1999,
pagine: 606 - 611
SICI:
1355-6037(199906)81:6<606:DTAOLI>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
CONVERTING ENZYME-INHIBITION; ANGIOTENSIN-II; HEART-FAILURE; BLOOD-PRESSURE; RECEPTOR ANTAGONISTS; CAPTOPRIL; PLASMA; TOLERABILITY; PERFORMANCE; EXERCISE;
Keywords:
acute myocardial infarction; angiotensin converting enzyme inhibitors; captopril; losartan;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Di Pasquale, P GF Ingrassia Hosp, Div Cardiol Paolo Borsellino, Via Val Platani 3, I-90144 GF Ingrassia Hosp Via Val Platani 3 Palermo Italy I-90144
Citazione:
P. Di Pasquale et al., "Does the addition of losartan improve the beneficial effects of ACE inhibitors in patients with anterior myocardial infarction? A pilot study", HEART, 81(6), 1999, pp. 606-611

Abstract

Objective-To verify the efficacy of the combination of captopril (75 mg day) and losartan (25 mg/day) in early postinfarction phases of reperfused anterior acute myocardial infarction. Design and patients-99 patients, hospitalised for suspected anterior acutemyocardial infarction within four hours from the onset of symptoms, were randomised into two groups: group A included 50 patients who received captopril 75 mg/day and placebo; group B included 49 patients who received captopril 75 mg/day within three days of admission plus losartan 12.5 mg, as a first dose, and 25 mg/day successively. An additional 23 patients with anterior acute myocardial infarction received losartan 25 mg alone and acted as controls (group C) to check the effects of losartan on plasma angiotensin II(AII) concentrations. Noradrenaline (norepinephrine) (NA) and All plasma concentrations were measured on the third and 10th day after admission in 93patients (35 from group A, 35 from group B, and 23 from group C). 90 days after admission patients underwent echocardiography to determine end systolic volume (ESV) and ejection fraction (EF). Results-Patients in groups A and B were similar with regard to age, sex, creatine kinase peak, EF, ESV: and risk factors. Group B (captopril plus losartan) patients showed a significant reduction in mean (SD) systolic blood pressure within the group (basal 128 (10) mm Hg; 10 days after admission 105 (9) mm Hg, p < 0.001), and in comparison with group A (captopril) patients (basal 127 (11) mm Hg; 10 days after admission 116 (10) mm Hg, p < 0.001). Diastolic blood pressure was also lower in group B patients versus group A (66 (11) v 77 (11) mm Hg). Group C (losartan) patients also showed a significant reduction in systolic blood pressure (131 (13) mm Hg down to 121 (12) mm Hg, p < 0.001). Neither NA nor AII plasma concentrations in groups A and B differed significantly in basal samples (NA 673 (138) v 675 (141) pg/ml; AII 12.77 (4.79) v 12.65 (4.71) pg/ml) or 10 days after admission (NA 283 (93) v 277 (98) pg/ml; All 5.31 (2.25) v 6.09 (3.31) pg/mg). However, patients in group C had higher plasma concentrations of AII (14.79 (5.7) pg/ml on the third day and 7.98 (4.92) pg/ml on the 10th day) than patients in either group A or B (p = 0.006). After 90 days following treatment, group B(captopril plus losartan) patients had a smaller ESV than patients in group A (captopril) and group C (losartan). Conclusion-The data suggest that the combination of captopril plus losartan is feasible in the early treatment of acute myocardial infarction patients, and it appears that this combination has more effect on ESV than captopril alone in the short term.

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Documento generato il 26/09/20 alle ore 11:28:03