2001-02-22
Reduction of exercise-induced myocardial ischemia during add-on treatment-with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade
Publication
Publication
Journal of the American College of Cardiology , Volume 37 - Issue 2 p. 470- 474
OBJECTIVES: We sought to study the effect of angiotensin-converting enzyme inhibition on exercise-induced myocardial ischemia. BACKGROUND: Although angiotensin-converting enzyme inhibitors have been shown to reduce ischemic events after myocardial infarction, few data are available regarding their direct anti-ischemic effects in patients with coronary artery disease. METHODS: We studied 43 patients (average age 63 ± 8 years) with exercise-induced myocardial ischemia (≥0.1 mV ST depression, despite optimal beta blockade) and normal left ventricular function (ejection fraction >0.50). In a double-blind, placebo-controlled parallel design, patients were treated with angiotensin-converting enzyme inhibitor (enalapril 10 mg twice daily) or placebo. Assessments were made after three weeks (short-term) and 12 weeks (long-term). RESULTS: At baseline, the groups were well matched for all clinical characteristics. After three weeks, there was a slight but not significant increase in time to 0.1 mV ST depression in both groups (p = NS); rate pressure product (RPP = heart rate × systolic blood pressure) was also unaffected. After 12 weeks, however, time to 0.1 mV ST depression further increased in the enalapril group (5.6 ± 1.9 min) but was unchanged in the placebo group (4.4 ± 1.3 min; p < 0.05 between groups). In contrast, RPP was not affected. Concentrations of both atrial and brain natriuretic peptides at peak exercise tended to be lower by enalapril, if compared to placebo (p = NS). CONCLUSIONS: Angiotensin-converting enzyme inhibition may reduce exercise-induced myocardial ischemia in patients with normal left ventricular function. Further studies are needed to elucidate the mechanisms involved.
Additional Metadata | |
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doi.org/10.1016/S0735-1097(00)01111-6, hdl.handle.net/1765/56095 | |
Journal of the American College of Cardiology | |
Organisation | Department of Internal Medicine |
van den Heuvel, A., Dunselman, P., Kingma, T., Verhorst, P. M., Boomsma, F., van Gilst, W., & van Veldhuisen, D. (2001). Reduction of exercise-induced myocardial ischemia during add-on treatment-with the angiotensin-converting enzyme inhibitor enalapril in patients with normal left ventricular function and optimal beta blockade. Journal of the American College of Cardiology, 37(2), 470–474. doi:10.1016/S0735-1097(00)01111-6 |