Captopril plus losartan in early post-infarction. Neurohormonal effects: a pilot study

Area of Science:

• Cardiology
• Pharmacology

Background:

• Angiotensin II (A II) formation suppression is key in ACE-inhibitor therapy.
• Tissue chymase can lead to A II level recovery during ACE-inhibitor treatment.
• Investigating combined captopril and losartan for early post-myocardial infarction care.

Purpose of the Study:

• To assess the feasibility, safety, and tolerability of combined captopril and losartan therapy.
• To determine the efficacy of this combination in reducing A II formation and action post-myocardial infarction.
• To evaluate hemodynamic responses in the early phase of anterior myocardial infarction.

Main Methods:

• Forty-four patients with acute myocardial infarction (AMI) were randomized into two groups.
• Group A received captopril (75 mg/day) plus placebo.
• Group B received captopril (75 mg/day) plus losartan (up to 25 mg/day).
• Plasma norepinephrine (NE) and A II levels were measured on days 3 and 10 post-admission.

Main Results:

• Combined captopril-losartan significantly reduced blood pressure compared to captopril alone (108 vs. 118 mmHg).
• No significant differences in norepinephrine or A II plasma levels were observed between groups.
• The combined treatment demonstrated feasibility and no significant adverse effects.

Conclusions:

• Combined captopril-losartan therapy is feasible and safe in the early post-infarction phase.
• This combination effectively lowers blood pressure without increasing A II levels.
• The treatment does not appear to stimulate A II formation via pathways affected by losartan alone.