ACE inhibitors or sartans in the management of myocardial infarction survivors?

Abstract

This paper is a review of current concepts regarding renin-angiotensin-aldosterone system blockade after myocardial infarction. The established classes of drugs such as ACE inhibitors, angiotensin II receptor blockers, or aldosterone inhibitors as well as novel direct renin inhibitors are discussed. While data from trials in hypertensive patients have suggested some benefit of ACE inhibitors, head-to-head comparisons in large multicenter trials have supported the notion that ACE inhibitors and angiotensin receptor blockers are effective, safe and comparable, yet their combinations do not seem appropriate. Aldosterone inhibitors are added in some indications, but renin inhibitors have yet not established their place in clinical practice. Renin-angiotensin-aldosterone system blockade is currently the mainstay of treatment of myocardial infarction survivors and in secondary prevention of coronary heart disease. Additional trials are warranted to identify the ideal level at which to block the whole system.