Acute blood pressure response to trandolapril and captopril in patients with left ventricular dysfunction after acute myocardial infarction

Objective Our purpose was to compare the blood pressure response to short-term treatment with captopril or trandolapril in patients with left ventricular (LV) dysfunction after acute myocardial infarction (AMI). Methods A multicenter, randomized, double-blind, double-dummy, parallel group study was performed. Treatment was initiated 3 to 10 days after the onset of symptoms. On day 1, patients received a single dose of captopril 6.25 mg, trandolapril 0.5 mg, or placebo in the morning. Treatment was then titrated upward over the next 5 days. Blood pressure was monitored with an automated device for the first 12 hours after dosing on day 1. Conventional blood pressure measurements were performed throughout the study. Results Of 205 patients treated in the study, 193 patients were evaluated for first-dose effects. In the captopril group, the maximum decrease in blood pressure occurred after 2 hours, and the magnitude of this decrease was significantly greater than in the other 2 groups: 8.8 ± 12/6.3 ± 8 mm Hg (captopril) versus 5.4 ± 10/3.1 ± 8 mm Hg (trandolapril) versus 2.4 ± 9/1.4 ± 7 mm Hg (placebo) (P < .01). In the trandolapril group, the maximum decrease occurred after 7 hours and the magnitude of this effect was similar in all 3 groups: 5.9 ± 11/3.6 ± 8 mm Hg (trandolapril) versus 4.3 ± 10/3.5 ± 8 mm Hg (captopril) versus 3.1 ± 11/2.8 ± 8 mm Hg (placebo) (not significant). Although there was a higher incidence of hypotension on day 1 in the captopril group, the overall incidence of hypotension during the study period was similar in both active treatment groups. Conclusion Because of differences in initial blood pressure response profiles, short-term treatment with trandolapril tended to be better tolerated than captopril in post-AMI patients with LV dysfunction. (Am Heart J 2002;143:313-8.)