Angiotensin receptor blockers and myocardial infarction

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7502.1270-b (Published 26 May 2005) Cite this as: BMJ 2005;330:1270

Authors' reply

  1. Martin H Strauss, consultant cardiologist (Dr.marty@bellnet.ca),
  2. Subodh Verma, scientist
  1. Division of Cardiology, North York General Hospital, 4001 Leslie Street, Suite 107, Toronto, ON, Canada M2K 2K9
  2. Division of Cardiac Surgery, Toronto General Hospital, Toronto, ON, Canada M5G 2C4

    Editor—We agree with McMurray et al that angiotensin receptor blockers have not been associated with increased myocardial infarction in all trials, although viewing myocardial infarction in concert with cardiovascular death may be more appropriate. For example, in OPTIMAAL cardiovascular mortality was higher with losartan (relative risk 1.17, 95% confidence interval 1.01-1.34) and myocardial infarction did not change. In RENAAL losartan actually decreased myocardial infarction by 26% and delayed the need for dialysis by 40 days, but once dialysis was required the mortality in the losartan group was 29% higher.1

    The VALIANT rate of myocardial infarction had not been published previously, and we thank the trialists for providing this information. VALIANT lasted only 24.7 …

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