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Blood Pressure Drug Holds Promise

November 11, 1999

ATLANTA (AP) _ Widely used blood pressure pills called ACE inhibitors can lower the risk of heart attacks and death by nearly 25 percent in people with bad hearts or diabetes, according to a new study.

Research released Wednesday suggests that ACE inhibitors should be added to the fistful of pills _ typically aspirin, beta blockers and cholesterol-lowering drugs _ already recommended for people with bad hearts.

``This extends the use of ACE inhibitors in a massively broad way,″ said Dr. Peter Sleight of Oxford University in England, one of the researchers.

The study found that people with clogged arteries or diabetes reduce their risk of heart attack, stroke or dying from heart disease by 22 percent if they take the medicine, even if they do not have high blood pressure.

The researchers said ACE inhibitors appear to be even more potent than aspirin _ now the mainstay of heart care _ at warding off heart trouble.

In the study, researchers tested the ACE inhibitor Altace, known generically as ramipril, for almost five years on 9,297 men and women in North and South America and Europe. They released their findings at a meeting in Atlanta of the American Heart Association.

``This is spectacular,″ said Dr. Robert M. Califf of Duke University. ``I’m starting all of my coronary disease patients on ramipril.″

Angiotensin converting enzyme inhibitors are routinely used to lower blood pressure and treat congestive heart failure. However, the latest study suggests the drugs also help heart patients who do not have these particular problems.

None of the volunteers in the new study had heart failure. And while some had hypertension, the condition was already well controlled by other drugs.

Experts believe Altace _ and probably other ACE inhibitors _ work by stopping the damaging effects of the enzyme angiotensin on the blobs of fatty plaque that narrow the heart’s blood vessels. When this soft plaque ruptures, it triggers the formation of a blood clot. This in turn can choke off blood flow in the artery, resulting in a heart attack.

Altace ``has a directly protective effect on the blood vessel wall,″ said Dr. Salim Yusuf of McMaster University, who led the study. The researchers theorize that angiotensin does its damage by activating blood cells called macrophages, which can dissolve the covering over risky plaque.

The drug’s main side effect is a cough, which is common with ACE inhibitors.

During 4 1/2 years of follow-up, 653 people _ or 14 percent _ of those taking Altace suffered a heart attack or stroke or died of cardiovascular causes. By comparison, 824 people, or 18 percent, of those getting dummy pills had such an outcome.

Those taking Altace also were less likely to need bypass surgery or angioplasty, to be diagnosed with diabetes or to suffer complications of diabetes.

The researchers calculated that it would be necessary to treat 1,000 people for four years to protect 70 of them from heart attacks, strokes and death.

The researchers said that while other ACE inhibitors probably have similar effects, this has not been proved. Other brands of ACE inhibitors include Capoten, Vasotec, Prinivel, Lotensin, Monopril, Univasc, Accupril and Mavik.

The results were scheduled to be published in the New England Journal of Medicine, which posted the data Wednesday on its Web site. The study was financed by the Medical Research Council of Canada and other sources.

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