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Angiotensin-converting enzyme inhibition with spirapril in patients with coronary artery disease
1Department of Clinical Pharmacology, University Clinic Frankfurt, Germany.
Insights
Spirapril, an ACE inhibitor, did not significantly reduce exercise-induced ischaemia in patients with coronary artery disease. This study found no improvement in anginal symptoms or ST-segment depression with spirapril treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) remains a leading cause of morbidity and mortality.
- Anti-ischaemic therapies aim to improve myocardial oxygen supply-demand balance.
- Angiotensin-converting enzyme (ACE) inhibitors are established treatments for cardiovascular conditions.
Purpose of the Study:
- To evaluate the anti-ischaemic effects of the ACE inhibitor spirapril.
- To assess spirapril's impact on exercise-induced ischaemia in patients with CAD.
- To determine if spirapril reduces anginal symptoms and nitrate consumption.
Main Methods:
- A randomized, double-blind, placebo-controlled, crossover trial was conducted.
- 19 patients with CAD and exercise-induced ST-segment depression participated.
- Patients received 2 weeks of spirapril and 2 weeks of placebo, with measurements of blood pressure, heart rate, and exercise testing.
Main Results:
- Spirapril did not significantly reduce resting blood pressure.
- Exercise-induced ST-segment depression was not significantly improved by spirapril.
- The blood pressure x heart rate product at maximum workload was significantly reduced (p < 0.05).
- Anginal attacks and nitrate consumption remained largely unchanged.
Conclusions:
- Spirapril did not demonstrate a significant reduction in exercise-induced ischaemia in normotensive patients with CAD.
- The study did not find evidence supporting spirapril's anti-ischaemic efficacy in this patient group.
- Further research may be needed to explore ACE inhibitors' role in specific CAD populations.
Abstract:
In a randomized double-blind, placebo-controlled, crossover trial, the potential anti-ischaemic action of the angiotensin-converting enzyme (ACE) inhibitor spirapril was studied in 19 patients with coronary artery disease (CAD) and reproducible exercise-induced ST-segment depression, but without hypertension or congestive heart failure. Measurements of blood pressure and heart rate as well as exercise-testing were performed after 2 weeks of treatment each with placebo and spirapril. Anginal attacks and consumption of short-acting nitrates were recorded in the patients' diaries. Resting blood pressure was not significantly reduced (143 +/- 20/89 +/- 10 mmHg vs 138 +/- 17/87 +/- 10 mmHg). The exercise-induced ST-segment depression, the main criterion for anti-ischaemic effect, was 2.17 +/- 1.72 mm after placebo and not significantly affected by spirapril (2.03 +/- 1.47 mm) despite a significant reduction in blood pressure x heart rate product at maximum workload (213 +/- 45.4 vs 197.5 +/- 36.8; p < 0.05). The number of anginal attacks per week and nitrate consumption remained virtually unchanged. A significant reduction of exercise-induced ischaemia in normotensive patients with CAD was not demonstrated with spirapril.