Angiotensin receptor blockers and myocardial infarction: Cautions voiced are biologically credible

doi:10.1136/bmj.330.7502.1270-a

BMJ 2005;330:1270 (28 May), doi:10.1136/bmj.330.7502.1270-a

Letter

Angiotensin receptor blockers and myocardial infarction

Cautions voiced are biologically credible

The first 150 words of the full text of this article appear below.

Editor—We agree with Verma and Strauss that it is naiveto consider that angiotensin receptor blockers are like angiotensinconverting enzyme (ACE) inhibitors, but without the cough.¹Although the evidence is conflicting, the hypothesis that angiotensinreceptor blockers may predispose to myocardial infarction whenused in preference to ACE inhibitors warrants further attention.

Long term clinical benefits of treatment with ACE inhibitors,including reduction in fatal and non-fatal myocardial infarction,are well established in chronic heart failure, hypertension,and after myocardial infarction.² These benefits persist, althoughserum concentrations of angiotensin II return to pre-treatmentvalues after long term treatment with ACE inhibitors.³

This implies that the mechanism(s) of benefit from ACE inhibitorsextend beyond simple antagonism of angiotensin II. The effectsof ACE inhibitors are related to the upstream blockade of therenin-angiotensin axis, which not only attenuates the conversionof angiotensin I to angiotensin II but also inhibits the . . . [Full text of this article]

Zaheer R Yousef, specialist registrar

zypusef@dircon.co.uk

Francisco Leyva, consultant cardiologist, Christopher Gibbs, consultant cardiologist

Department of Cardiology, Good Hope Hospital, Sutton Coldfield, West Midlands B75 7RR