Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction

• Published in: PloS one 2023-03, Vol.18 (3), p.e0281460-e0281460
• Main Authors: Lee, Jae-Geun, Joo, Seung-Jae, Kim, Song-Yi, Choi, Joon-Hyouk, Boo, Ki Yung, Hwang, Jin-Yong, Hur, Seung-Ho, Jeong, Myung Ho
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Angina pectoris; Angiotensin; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Antihypertensives; Beta blockers; Biology and Life Sciences; Blood pressure; Clinical outcomes; Complications and side effects; Conversion; Death; Diabetes; Enzyme inhibitors; Enzymes; Health aspects; Heart; Heart attack; Heart attacks; Hospitalization; Humans; Hypertension; Hypertension - chemically induced; Hypertension - complications; Hypertension - drug therapy; Medicine and Health Sciences; Mortality; Myocardial infarction; Myocardial Infarction - chemically induced; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Peptidyl-dipeptidase A; Receptors; Renin; Renin-angiotensin system; Risk factors; Stroke; Therapy; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0281460

There has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a first-line inhibitor of renin-angiotensin system (RASI) in patients with acute MI (AMI), but ARB is also frequently used to control blood pressure. This study investigated the association of ARB vs. ACEI with the long-term clinical outcomes in hypertensive patients with AMI. Among patients enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH, 4,827 hypertensive patients, who survived the initial attack and were taking ARB or ACEI at discharge, were selected for this study. ARB therapy was associated with higher incidence of 2-year major adverse cardiac events, cardiac death, all-cause death, MI than ACEI therapy in entire cohort. After propensity score-matching, ARB therapy was still associated with higher incidence of 2-year cardiac death (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20-2.14; P = 0.001), all-cause death (HR, 1.81; 95% CI, 1.44-2.28; P < 0.001), and MI (HR, 1.76; 95% CI, 1.25-2.46; P = 0.001) than the ACEI therapy. It was concluded that ARB therapy at discharge in hypertensive patients with AMI was inferior to ACEI therapy with regard to the incidence of CD, all-cause death, and MI at 2-year. These data suggested that ACEI be a more appropriate RASI than ARB to control BP in hypertensive patients with AMI.