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Angiotensin-Converting Enzyme Inhibitors and the puplic water supplies
Submit responseI read with interest your systemic review article. The answer for these key questions , mentioned in the article, are imperative to know whether Angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARB) should be added to the standard treatment of coronary artery disease (CAD) with preserved ventricular dysfunction.
The authors have done great job reviewing the literature to find those answers. Taking a glance at the last recent related randomized clinical trails; ONTARGET trial evaluated the effect of these drugs on left ventricular hypertrophy (LVH) in high-risk patients for cardiovascular disease without heart failure. Although this study showed "no inferiority" for ARB compare to ACEI; the robust available literature about ACEIs still favors using them as the first line. Furthermore; the combination of ACEI and ARB in this study was not superior to ACEI alone. TRANSCEND trial assessed the same patients group who are intolerant to ACE. It showed that telmisartan is more effective than placebo in reducing LVH.
It is not surprising to see a favorable effect of the ACEIs and is consistent with our current knowledge based on the available literature. This, in fact, reminds me of a quote of a bright nephrologist in our institution: "ACEIs should be added to the public water supplies!"
Conflict of Interest:
None declared