PP.35.04

Abstract

Objective: A relationship between blood pressure reduction and the prevention of MI has been established by previous studies. However, large differences of benefit have been reported in randomized clinical trials with RAAS blockers and we decided to explore if there was a different impact of lowering BP with ACE inhibitors and ARBs regarding the rate of MI. Design and method: This analysis included 22 major randomized clinical trials that enrolled 216 715 patients with hypertension and/or high cardiovascular risk, receiving a RAAS blocker in the active treatment (losartan, candesartan, valsartan, telmisartan, olmesartan, irbesartan, enalapril, ramipril, trandolapril, quinapril or perindopril) and reporting the rate of MI. Relative risk reduction was plotted against differences in SBP between active treatment and control for each trial and the relation between BP reduction and MI was evaluated for ACE inhibitors and ARBs with a linear regression. Results: When evaluated according to the slope of linear regressions, the correlation between the risk of MI and blood pressure reduction was similar between ARBs and ACE inhibitors. Consistently with previous studies, for every 10 mm Hg reduction of SBP, a 15% relative risk reduction for MI was observed. However, the intrinsic cardioprotective effects appeared to be different among classes. Below a minimal SBP difference of 10 mm Hg, the risk of MI was actually elevated in the ARB group with a 13% increase of MI vs comparator for a similar BP effect. Inversely, a beyond BP effect was confirmed for ACE inhibitors with a -9% reduction of MI (-13% for perindopril) vs comparator for a similar BP decrease.Conclusions: Our study confirmed a relationship of the rate of MI to the extent of SBP reduction. However, there is an apparent excess of MI below a BP difference of 10 mm Hg with ARBs while ACE inhibitors have a beyond BP benefit.