Background: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease(CA...Background: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease(CAD). Methods and Results: An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14 531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61 835 patient-years of follow-up, treatment with either a verapamil sustained release(SR) or atenolol antihypertensive strategy resulted in greater blood pressure control in Hispanic patients, and Hispanic patients were at significantly lower risk of experiencing a nonfatal myocardial infarction, nonfatal stroke, or death(hazard ratio[HR] 0.87, 95%CI 0.78-0.97). Hispanic ethnicity was associated with an increase(HR 1.19, 95%CI 1.04-1.36), and randomization to the verapamil SR strategy was associated with a decrease(HR 0.85, 95%CI 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SR strategywas associated with reduced risk of new-onset diabetes, whereas increasing doses of atenolol and hydrochlorothiazide in the atenolol strategy were associated with increased risk of new-onset diabetes. Conclusions: The Hispanic cohort of INVEST had better blood pressure control and lower risk of adverse cardiovascular outcomes compared with the non-Hispanic cohort. A verapamil SR strategy is an alternative to an atenolol strategy for the treatment of Hispanic patients with hypertension and CAD and can reduce the risk of new-onset diabetes.展开更多
Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In t...Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In the trandolapril cardiac evaluation(TRACE) study, 1749 patients with LVD(ejection fraction≤ 35% ) were randomized to trandolapril(n=876) or placebo(n=873) 3- 7 days post- MI. Enrolment lasted from 1990 to 1994; on- treatment follow- up ranged from 2 to 4 years. At study closure, all patients were recommended continued ACE inhibitor use. National registries were used to track deaths and hospitalizations until 2002. Mortality was analysed with Cox proportional hazard models and hospitalization with Poisson regression models(models adjusted for observation time). Over 10- 12 years of follow- up, a total of 1283 deaths and 9220 hospitalizations were registered. Compared with the placebo group, the trandolapril group had a significantly reduced risk of all- cause mortality(relative risk 0.89, 95% CI 0.80- 0.99, P=0.03), all- cause hospitalizations(rate ratio 0.92, 95% CI 0.88- 0.96, P< 0.001), and cardiovascular hospitalizations(rate ratio 0.95, 95% CI 0.91- 1.00, P=0.047), including congestive heart failure hospitalizations(rate ratio 0.85, 95% CI 0.77- 0.93, P< 0.001). Conclusion: In patients with LVD, use of trandolapril shortly after an MI for 2- 4 years has long- term benefits. The beneficial effect on mortality and hospitalization rates is maintained for at least 10- 12 years.展开更多
Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity de...Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity despite similar suppression of the circulating renin-angiotensin system. To test this hypothesis in a clinical setting, we randomized subjects with chronic heart failure to receive the low tissue affinity ACE inhibitor enalapril or the high tissue affinity ACE inhibitor trandolapril, and assessed the degree of circulating and vascular renin-angiotensin system suppression. Vascular renin-angiotensin system suppression was determined by measuring the pressor response to intravenous injections of angiotensin I. Circulating reninangiotensin system suppression was determined by measuring plasma angiotensin II. Vascular and circulating renin-angiotensin system suppression, endothelial function(flow-mediated vasodilation), and maximal exercise capacity(peak oxygen uptake) were assessed after a 4-week run-in period on open-label enalapril 40 mg/day and after 8 weeks of randomized double-blind treatment with enalapril 40 mg/day or trandolapril 4 mg/day. Twenty-six men and 4 women(mean age 52±11 years; mean left ventricular ejection fraction 25±9%; New York Heart Association class II[n=16] and III[n=14]) were studied. After a 2-month randomized treatment period, vascular renin-angiotensin system suppression, circulating renin-angiotensin system suppression, endothelial function, and exercise capacity did not differ between subjects treated with enalapril and those treated with trandolapril. Despite substantial differences in the tissue affinity of enalapril and trandolapril, the degree of vascular renin-angiotensin system suppression achievedwith these agents did not differ in subjects with chronic heart failure during long-term therapy.展开更多
文摘Background: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease(CAD). Methods and Results: An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14 531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension. After 61 835 patient-years of follow-up, treatment with either a verapamil sustained release(SR) or atenolol antihypertensive strategy resulted in greater blood pressure control in Hispanic patients, and Hispanic patients were at significantly lower risk of experiencing a nonfatal myocardial infarction, nonfatal stroke, or death(hazard ratio[HR] 0.87, 95%CI 0.78-0.97). Hispanic ethnicity was associated with an increase(HR 1.19, 95%CI 1.04-1.36), and randomization to the verapamil SR strategy was associated with a decrease(HR 0.85, 95%CI 0.76-0.95), in the risk of new-onset diabetes. Use of trandolapril in the verapamil SR strategywas associated with reduced risk of new-onset diabetes, whereas increasing doses of atenolol and hydrochlorothiazide in the atenolol strategy were associated with increased risk of new-onset diabetes. Conclusions: The Hispanic cohort of INVEST had better blood pressure control and lower risk of adverse cardiovascular outcomes compared with the non-Hispanic cohort. A verapamil SR strategy is an alternative to an atenolol strategy for the treatment of Hispanic patients with hypertension and CAD and can reduce the risk of new-onset diabetes.
文摘Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In the trandolapril cardiac evaluation(TRACE) study, 1749 patients with LVD(ejection fraction≤ 35% ) were randomized to trandolapril(n=876) or placebo(n=873) 3- 7 days post- MI. Enrolment lasted from 1990 to 1994; on- treatment follow- up ranged from 2 to 4 years. At study closure, all patients were recommended continued ACE inhibitor use. National registries were used to track deaths and hospitalizations until 2002. Mortality was analysed with Cox proportional hazard models and hospitalization with Poisson regression models(models adjusted for observation time). Over 10- 12 years of follow- up, a total of 1283 deaths and 9220 hospitalizations were registered. Compared with the placebo group, the trandolapril group had a significantly reduced risk of all- cause mortality(relative risk 0.89, 95% CI 0.80- 0.99, P=0.03), all- cause hospitalizations(rate ratio 0.92, 95% CI 0.88- 0.96, P< 0.001), and cardiovascular hospitalizations(rate ratio 0.95, 95% CI 0.91- 1.00, P=0.047), including congestive heart failure hospitalizations(rate ratio 0.85, 95% CI 0.77- 0.93, P< 0.001). Conclusion: In patients with LVD, use of trandolapril shortly after an MI for 2- 4 years has long- term benefits. The beneficial effect on mortality and hospitalization rates is maintained for at least 10- 12 years.
文摘Experimental studies suggest that angiotensin-converting enzyme(ACE) inhibitors with high tissue affinity confer a greater degree of vascular renin-angiotensin system suppression than those with low tissue affinity despite similar suppression of the circulating renin-angiotensin system. To test this hypothesis in a clinical setting, we randomized subjects with chronic heart failure to receive the low tissue affinity ACE inhibitor enalapril or the high tissue affinity ACE inhibitor trandolapril, and assessed the degree of circulating and vascular renin-angiotensin system suppression. Vascular renin-angiotensin system suppression was determined by measuring the pressor response to intravenous injections of angiotensin I. Circulating reninangiotensin system suppression was determined by measuring plasma angiotensin II. Vascular and circulating renin-angiotensin system suppression, endothelial function(flow-mediated vasodilation), and maximal exercise capacity(peak oxygen uptake) were assessed after a 4-week run-in period on open-label enalapril 40 mg/day and after 8 weeks of randomized double-blind treatment with enalapril 40 mg/day or trandolapril 4 mg/day. Twenty-six men and 4 women(mean age 52±11 years; mean left ventricular ejection fraction 25±9%; New York Heart Association class II[n=16] and III[n=14]) were studied. After a 2-month randomized treatment period, vascular renin-angiotensin system suppression, circulating renin-angiotensin system suppression, endothelial function, and exercise capacity did not differ between subjects treated with enalapril and those treated with trandolapril. Despite substantial differences in the tissue affinity of enalapril and trandolapril, the degree of vascular renin-angiotensin system suppression achievedwith these agents did not differ in subjects with chronic heart failure during long-term therapy.
