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It Is Time to Stop Comparing Blood Pressure–Lowering Drugs With Placebo
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In the March 27 issue of the ARCHIVES, the Perindopril and Remodeling in Elderly with Acute Myocardial Infarction (PREAMI) investigators showed that the use of an angiotensin-converting enzyme (ACE) inhibitor in patients who recovered from an acute myocardial infarction, with mildly depressed or preserved ejection fraction ( 40%), lowered the incidence of left ventricular remodeling.1 The internal validity of this double-blind trial, with meticulous evaluation of outcome, is undisputable. The conception of this trial, however, particularly with the choosing of a placebo control arm, casts doubt about its external validity. The absence of effect on hard outcomes was expected, in view of the small sample size, but even the effect on cardiac remodeling can be attributed to the blood pressure–lowering effect of perindopril. The magnitude of this effect, despite being statistically significant, cannot be fully captured by occasional office blood pressure measurement, as it was shown in the . . . [Full Text of this Article]
AUTHOR INFORMATION
Flávio Danni Fuchs, MD, PhD
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It Is Time to Stop Comparing Blood Pressure–Lowering Drugs With Placebo—Reply
Roberto Ferrari and for the PREAMI Investigators
Arch Intern Med. 2006;166(16):1786-1787.
EXTRACT
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Effects of Angiotensin-Converting Enzyme Inhibition With Perindopril on Left Ventricular Remodeling and Clinical Outcome: Results of the Randomized Perindopril and Remodeling in Elderly With Acute Myocardial Infarction (PREAMI) Study
The PREAMI Investigators*
Arch Intern Med. 2006;166(6):659-666.
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