ACE Inhibitors Prevent Heart Attack, Stroke

Study Shows High Blood Pressure Drug Lowers Risk of Sudden Cardiac Death

Sept. 6, 2004 -- The risk of sudden cardiac death and nonfatal cardiac arrest can be reduced by a type of high blood pressure medication -- angiotensin-converting enzyme (ACE) inhibitors.

Past studies have shown that these medications reduce the risk of heart attack and stroke in people with heart disease. Now comes word that they can also dramatically lower the risk of sudden cardiac death and nonfatal cardiac arrest in people at high risk.

In a follow-up study comparing the ACE inhibitor Altace with vitamin E or placebo treatment, people taking Altace had a 21% reduction in unexpected deaths, deaths due to cardiac arrest, or nonfatal cardiac arrest.

These patients had been taking their other heart disease drugs such as beta blockers, cholesterol- lowering statins, and blood thinners, which makes the results of this follow-up study even more impressive, says American Heart Association spokeswoman Ann Bolger, MD.

"This research underscores the importance of using this class of drugs," the University of California, San Francisco associate professor of medicine, tells WebMD. "The challenge for us as health care providers is to make sure that people who should be on these drugs are taking them."

HOPE Revisited

ACE inhibitors are widely prescribed to patients following heart attacks and for those with heart failure. They are high blood pressure pills which work by preventing blood vessels from narrowing and alleviating the work force on the heart.

But while they are also recommended for people with high blood pressure, diabetes, and others at risk for heart attacks and stroke, they are not prescribed as much as they should be, researcher Koon K. Teo, MD, PhD, tells WebMD.

In the HOPE Trial, Teo and colleagues showed that people at high risk for heart disease who were taking Altace had significantly fewer heart attacks and strokes than high-risk patients taking vitamin E (an antioxidant) or placebo. The trial which involved 9,300 people did not include data on sudden cardiac death and nonfatal cardiac arrest, however.

The researchers now report that after an average of 4.5 years of treatment, 3% of the patients taking the ACE inhibitor had died from sudden cardiac death or experienced a nonfatal cardiac arrest, compared with 4% taking placebo. This translates into a 21% reduction in risk of sudden death or nonfatal cardiac arrest in people with heart disease who take Altace.

Although Altace was the only ACE inhibitor used in the trial, and the study was supported by its Canadian marketer Aventis Pharma Inc., Teo says findings from other studies make it clear that ACE inhibitors as a category of antihypertensive drugs are highly effective in reducing cardiovascular risk. It is also clear, he adds, that other types of drugs play an important role as well.

'Amazing Medications'

In the HOPE study, roughly three out of four patients were also taking a blood thinner, a third were taking cholesterol-lowering statins, half were taking calcium channel blockers (another type of high blood pressure medication), and two out of five were taking beta-blockers.

"We showed that even when people were on other medications, they benefited from being on an ACE inhibitor," says Teo, who is a professor of medicine at Ontario's McMaster University.

Bolger says she hopes this and other studies showing the benefits of drug treatment "light a fire under us all" to make sure patients get the medications they need.

"We now have a tremendous number of tools including ACE inhibitors, beta-blockers, antiplatelet (blood thinners) agents, and statins," she says. "These are amazing medications and when used correctly they can really change the whole outlook for someone who has had a heart attack or stroke. We need to do a better job of getting the message across to patients that if they stay on the right medications their outlook is very good."

Show Sources

SOURCES: Teo et al. Circulation, Sept. 14, 2004; online edition. Koon K. Teo, MD, PhD, professor of medicine, McMaster University, Hamilton, Ontario, Canada. Ann Bolger, MD, associate professor of medicine, University of California at San Francisco; spokeswoman, American Heart Association.
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