In reply
We are in agreement with Fuchs in that blood pressure–lowering drugs should not be tested against placebo in patients with a clear indication for blood pressure reduction.
However, this is not the case with the PREAMI population.1 The PREAMI study enrolled elderly post–myocardial infarction patients with preserved left ventricular function (59%) and normal blood pressure (125/74 mm Hg). In 1998, when the PREAMI study started, there was no evidence of the benefits of ACE inhibition in this important subset of patients at higher risk for cardiovascular morbidity and mortality.
The relevant national and European authorities, when specifically asked about the publication of the European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA) study, recommended the continuation of the trial because of the lack of data in this population.2 Other studies of ACE inhibitors vs placebo in a similar population failed to show . . . [Full Text of this Article]
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