The Pharmaceutical Journal
Vol 273 No 7325 p706
13 November 2004

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ACE inhibitors not needed in stable heart disease

Patients with stable heart disease who are already receiving standard therapy are not likely to benefit from additional treatment with angiotensin-converting enzyme inhibitors, results from a new study indicate.

The PEACE (prevention of events with angiotensin converting enzyme inhibition) trial tested whether ACE inhibitors provide added benefits to heart disease patients who have relatively good heart function. It involved over 8,000 patients who did not have heart failure, and who had normal or near normal left ventricular function. They were randomly assigned to either 4mg daily of trandolapril (Gopten, Odrik) or to placebo.

Most patients (70 per cent) were being treated with lipid-lowering medicines and a similar proportion (72 per cent) had previously had coronary revascularisation.

After an average follow-up of 4.8 years, no significant differences in the primary end point — a composite of death from cardiovascular causes, non-fatal myocardial infarction, or revascularisation — were observed. And, although trandolapril lowered systolic blood pressure by an average of 4.4mmHg, the reduction did not have a significant effect on patients’ outcomes.

Eugene Braunwald, one of the investigators, based at the cardiovascular division of Brigham and Women’s Hospital in Boston, Massachusetts, said: “This study indicates that many patients with coronary heart disease whose heart muscle is in good shape and who receive intense treatment including revascularisation and lipid-lowering drugs do not gain extra cardiovascular protection from ACE inhibitors.” He added: “These lower-risk patients can avoid side effects and the added expense of ACE inhibitors without putting themselves at additional risk for cardiovascular complications.” The researchers suggest that the entry criteria used in the trial may help prescribers decide which patients do not need ACE inhibitors.

Data from the trial were presented at the American Heart Association scientific sessions in New Orleans earlier this week. They are also published in The New England Journal of Medicine (2004;351:2058).