Adding ACE inhibitor doesn’t improve outcomes in stable angina and normal LVEF

Q&A

J Fam Pract. 2005 February;54(2):105-113

CLINICAL QUESTION: Does adding an angiotensin-converting enzyme inhibitor improve outcomes among patients with stable angina and no evidence of heart failure?
STUDY DESIGN: Randomized controlled trial (double-blinded)
ALLOCATION: Concealed
SETTING: Outpatient (any)
SYNOPSIS: The HOPE and EUROPA trials found that ACE inhibitors improve cardiovascular outcomes in patients with vascular disease but with no evidence of overt heart failure. This study attempted to extend these findings to an even lower-risk group using the ACE inhibitor trandolapril (Mavik). The researchers recruited patients older than 50 years with documented coronary artery disease and a left ventricular ejection fraction (LVEF) >40%, excluding patients in poor health, with renal failure, recent unstable angina, or who had recently used an ACE inhibitor. Only patients who tolerated the active drug during a run-in phase were allowed into the study, a step that increases the likelihood of finding a benefit for the drug. The mean age of participants was 65 years, 18% were women, 55% had had a myocardial infarction (MI), 92% were white, and 17% had diabetes. Patients were randomized (allocation concealed) to trandolapril 2 mg per day, increased to 4 mg per day if tolerated, or matching placebo.

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