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. 2023 Mar 9;18(3):e0281460.
doi: 10.1371/journal.pone.0281460. eCollection 2023.

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

Jae-Geun Lee  1   2 , Seung-Jae Joo  1   2 , Song-Yi Kim  1   2 , Joon-Hyouk Choi  1   2 , Ki Yung Boo  2 , Jin-Yong Hwang  3 , Seung-Ho Hur  4 , Myung Ho Jeong  5 ; KAMIR-NIH investigators
Affiliations

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

Jae-Geun Lee et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection of patients for analysis.
ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; KAMIR-NIH, Korean Acute Myocardial Infarction Registry-National Institutes of Health; PSM, propensity score-matching.
Fig 2
Fig 2. Kaplan-Meier curves and adjusted hazard ratios for 2-year clinical events in propensity score-matched patients with ARB vs. ACEI.
(A) All-cause death. (B) Cardiac death. (C) Myocardial infarction. ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; HR, hazard ratio.
Fig 3
Fig 3. Subgroup analysis for myocardial infarction in propensity score-matched patients with ARB vs. ACEI.
ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; HR, hazard ratio; MI; myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; LAD, left anterior descending artery; LVEF, left ventricular ejection fraction; STEMI, ST-elevation myocardial infarction.
Fig 4
Fig 4. Landmark analysis for MACE and recurrent MI among patients who were event-free at 1-year after propensity score matching.
ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; HR, hazard ratio, MACE, major adverse cardiac events; MI, myocardial infarction.
Fig 5
Fig 5. Adjusted hazard ratios of 2-year recurrent myocardial infarction in propensity score-matched cohort with ARB vs. ACEI according to generic names of ARB.
ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval.
See this image and copyright information in PMC

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