This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Strauss, M. H. Articles by Hall, A. S. Search for Related Content PubMed PubMed Citation Articles by Strauss, M. H. Articles by Hall, A. S. Related Collections Congestive Cardiovascular Pharmacology ACE/Angiotension receptors Clinical Studies Acute myocardial infarction Receptor pharmacology

(Circulation. 2006;114:838-854.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Do angiotensin receptor blockers increase the risk of myocardial infarction?

Angiotensin Receptor Blockers May Increase Risk of Myocardial Infarction

Unraveling the ARB-MI Paradox

Martin H. Strauss, MD, FRCPC; Alistair S. Hall, MB ChB, PhD, FRCP(UK)

From the Division of Cardiology, North York General Hospital, Toronto, Canada (M.H.S.), and Clinical Cardiology, British Heart Foundation Research Centre at Leeds, Leeds, United Kingdom (A.S.H.).

Correspondence to Dr Martin H. Strauss, North York General Hospital, Division of Cardiology, 107-4800 Leslie St, Toronto, Canada, M2J 2K9. E-mail dr.marty@bellnet.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

"To know that we know what we know, and to know that we do not know what we do not know, that is true knowledge."

— —Copernicus (1473–1543)

Angiotensin-converting enzyme inhibitors (ACEIs) play an important role in the management of patients at increased cardiovascular (CV) risk. ACEIs reduce both myocardial infarction (MI) and mortality in patients with symptomatic congestive heart failure or asymptomatic left ventricular dysfunction,¹ as evidenced by a class I recommendation in the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines.² Early administration of an ACEI after an MI reduces 30-day mortality by &7%.³ In patients with established vascular disease but normal left ventricular function, ACEIs reduce mortality,⁴ MI,^4,5 stroke,^4,6 and new-onset congestive heart failure.^4,6 ACEIs are recommended as standard therapy in patients with established vascular disease in the ACC⁷ and European Society of Cardiology⁸ guidelines, and this recommendation is independent of left ventricular function or concomitant hypertension.

The unique cardioprotective benefits of ACEIs are also observed in patients with diabetes mellitus, who may or may not have coexistent atherosclerosis,⁹ and are considered a first priority in macrovascular risk reduction by the Canadian Diabetes Association and others.¹⁰ Additionally, ACEIs exert powerful nephroprotection and offer marked CV risk reduction in diabetic patients with concomitant nephropathy.^11,12

Angiotensin II (Ang II) type 1 (AT₁) receptor blockers (ARBs), first introduced in 1995, also inhibit the renin angiotensin system (RAS) in a mechanistically distinct fashion from ACEIs. Compared with ACEIs, which reduce the synthesis of Ang II, ARBs competitively and . . . [Full Text of this Article]

This article has been cited by other articles:

				M. H. Strauss and A. Hall Angiotensin Receptor Blockers Should Be Regarded as First-Line Drugs for Stroke Prevention in Both Primary and Secondary Prevention Settings: No Stroke, September 1, 2009; 40(9): 3161 - 3162. [Full Text] [PDF]

				R. Ferrari Treatment with angiotensin-converting enzyme inhibitors: insight into perindopril cardiovascular protection Eur. Heart J. Suppl., September 1, 2008; 10(suppl_G): G13 - G20. [Abstract] [Full Text] [PDF]

				M. Agirbasli, A. Cincin, and O. A Baykan Short-term effects of angiotensin receptor blockers on blood pressure control, and plasma inflammatory and fibrinolytic parameters in patients taking angiotensin-converting enzyme inhibitors Journal of Renin-Angiotensin-Aldosterone System, March 1, 2008; 9(1): 22 - 26. [Abstract] [PDF]

				M. Hudson, E. Rahme, H. Behlouli, R. Sheppard, and L. Pilote Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure Eur J Heart Fail, September 1, 2007; 9(9): 964 - 964. [Full Text] [PDF]

				A. S Hall and M. H Strauss More about the "ARB MI paradox" Heart, September 1, 2007; 93(9): 1011 - 1014. [Abstract] [Full Text] [PDF]

				J. S. Borer Angiotensin-converting enzyme inhibition: a landmark advance in treatment for cardiovascular diseases Eur. Heart J. Suppl., September 1, 2007; 9(suppl_E): E2 - E9. [Abstract] [Full Text] [PDF]

				A. Muthumala, H. Montgomery, J. Palmen, J. A. Cooper, and S. E. Humphries Angiotensin-Converting Enzyme Genotype Interacts With Systolic Blood Pressure to Determine Coronary Heart Disease Risk in Healthy Middle-Aged Men Hypertension, August 1, 2007; 50(2): 348 - 353. [Abstract] [Full Text] [PDF]

				J.-G. Wang, Y. Li, S. S. Franklin, and M. Safar Prevention of Stroke and Myocardial Infarction by Amlodipine and Angiotensin Receptor Blockers: A Quantitative Overview Hypertension, July 1, 2007; 50(1): 181 - 188. [Abstract] [Full Text] [PDF]

				N. M. Kaplan Clinical Trials for Hypertension: Expectations Fulfilled and Unfulfilled Hypertension, February 1, 2007; 49(2): 257 - 259. [Full Text] [PDF]