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INTRODUCTION Angiotensine II has a prominent role in the pathogenesis and further evolution of the atherosclerotic disease (1,2). It has been shown in 2 large clinical trials that angiotensine-converting enzyme (ACE) inhibitors can significantly prevent serious cardiovascular events in patients at high risk. The "Heart Outcome Prevention Evaluation" (HOPE) study (3) randomized 9297 high risk patients with age 55 years and proven atherosclerotic disease (coronary, cerebrovascular or peripheral) or diabetes mellitus with an additional risk factor (arterial hypertension, hypercholesterolemia, low HDL-cholesterol, smoking or micro-albuminuria) to a treatment with ramipril 10 mg per day or placebo for a mean follow-up of 4,5 years. The primary composite endpoint was myocardial infarction (MI), stroke or cardiovascular death. In the group of patients treated with ramipril, a relative risk reduction (RRR) of 22% of the primary endpoint was noticed compared to the placebo treatment (p 0,001) with in addition a highly significant reduction in several secondary endpoints. In the "European trial on reduction of cardiac events with perindopril and stable coronary artery disease" (EUROPA) (4), 13655 patients, age 55 years and proven coronary artery disease were randomised to a treatment with perindopril 8 mg per day or placebo. After a mean follow up of 4,2 years, a RRR of the composite primary endpoint (cardiovascular death, MI or cardiac arrest) of 20% (p= 0,0003) was seen in favor of the patients treated with perindopril. Questions at that time were whether a treatment with an angiotensin-receptor blocker (ARB) could be as effective in the prevention of cardiovascular complications for patients at high risk and furthermore of the combination of an ACE inhibitor with an ARB could not be even more effective than single drug therapy with an ACE inhibitor. The answers on this questions were evaluated in the ONTARGET study program.

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1 mars
Acta Clinica Belgica

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