Effects of the Combination of Candesartan plus Captopril in Elderly Patients with Anterior Myocardial Infarction: A Pilot Study

Author： Di Pasquale P.

Publisher： Adis International

ISSN： 1173-2563

Source： Clinical Drug Investigation, Vol.19, Iss.3, 2000-03, pp. : 173-182

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Abstract

Objective: To verify the feasibility, tolerability and efficacy of the combination of captopril (75 mg/day) and candesartan (8 mg/day) in early postinfarction phases of not thrombolysed and unreperfused anterior acute myocardial infarction (AMI) in elderly patients.Design and Patients: 71 patients (aged >65 years) hospitalised for anterior AMI were randomised in a double-blind manner into two groups: group A included 35 patients who received captopril 75 mg/day within 3 days of admission plus candesartan 4mg, as a first dose, and 8 mg/day successively; group B included 36 patients who received captopril 75 mg/day and placebo. 90 days after admission, patients underwent echocardiography to determine end-systolic volume (ESV) and ejection fraction (EF), end-diastolic diameter (EDD), E/A ratio, and E deceleration time.Results: Patients in both groups were similar with regard to age, gender, creatine kinase peak, EF, ESV and risk factors. Six patients died during the trial and results reflect data from 65 patients who completed the 90-day study period. Group A (captopril plus candesartan; n = 32) patients showed a significant reduction in mean (SD) systolic blood pressure within the group (basal 138 ± 16mm Hg); 10 days after admission 112 ± 15mm Hg (p < 0. 001), and in comparison with group B (captopril; n = 33) patients (basal 137 ± 8 mm Hg); 10 days after admission 121 ± 13mm Hg (intragroup p < 0. 001, between the two groups p = 0. 009). Diastolic blood pressure was also lower in group A patients versus group B patients at 10 days after admission (71 ± 12 vs 79 ± 14mm Hg; p = 0. 012). At 90 days after admission, group A patients had a smaller ESV than patients in group B (56. 5 ± 10 vs 62. 3 ± 11 ml/m; p = 0. 03). The mitral E/A ratio was higher in group A than group B (0. 71 ± 0.16 vs 0. 63 ± 0.15; p = 0. 042). In addition, group A showed an increase of E/A ratio at 90 days after admission (p < 0. 001). There were no significant differences between the two groups in serum creatinine, blood urea and serum potassium levels.Conclusion: The data suggest that the combination of captopril plus candesartan is feasible in the early treatment of AMI in elderly patients, and it appears that this combination has more effect on ESV and E/A ratio than captopril alone in the short term.