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Therapy of acute myocardial infarction
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Joshua M. Stolker, Michael W. Rich
Early administration of an ACEI to acute MI patients has been evaluated in several large trials. The first of these, the second Cooperative New Scandinavian Enalapril Survival Study (CONSENSUS-2), was discontinued after 6000 patients were enrolled due to a higher frequency of adverse outcomes in patients receiving IV enalapril (97). Moreover, patients over 70 years of age experienced an increased incidence of serious hypotension. In contrast, the third Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI-3) and ISIS-4 trials reported small but statistically significant reductions in mortality in patients receiving oral captopril or lisinopril within 24 hours of MI onset (98,99). In addition, patients 70 years or older treated with lisinopril in GISSI-3 experienced a 14% reduction in the combined endpoint of death or severe left ventricular dysfunction at 6-month follow-up (p = 0.01) (100). The Survival of Myocardial Infarction Long-term Evaluation (SMILE) investigators randomized 1556 patients with anterior MI who were not candidates for fibrinolytic therapy to either the ACEI zofenopril or placebo within the first 24 hours after symptom onset (101). The incidence of death or severe HF at 6-week follow-up was reduced 34% by zofenopril, and this benefit was maintained for one year. Moreover, the absolute benefit was threefold greater in individuals over 65 years of age compared with younger patients.
Main Classes of Drugs
Published in Jerome Z. Litt, Neil H. Shear, Litt's Drug Eruption & Reaction Manual, 2017
ACE inhibitorBenazeprilCaptoprilCilazaprilEnalaprilFosinoprilImidaprilLisinoprilMoexiprilPerindoprilQuinaprilRamiprilTrandolaprilZofenopril
Extemporaneous combination therapy with nebivolol/zofenopril in hypertensive patients: usage in Italy
Published in Current Medical Research and Opinion, 2022
Massimo Volpe, Valeria Pegoraro, Ilaria Peduto, Franca Heiman, Suada Meto
Nebivolol is a third generation long-acting and highly selective β1-adrenergic receptor antagonist, which is approved for the treatment of hypertension in the United States, as well as for the treatment of hypertension and chronic heart failure in Europe. Several studies on nebivolol have shown significant reduction of BP, heart rate and peripheral resistance, and increase of stroke volume with the preservation of cardiac output as well as improvement of coronary flow reserve. Nebivolol has shown favorable effects on central BP, aortic stiffness and endothelial dysfunction24. Furthermore, nebivolol exerts neutral or even favorable effects on both carbohydrate and lipid metabolism25 and has a more favorable safety profile than the classical BBs, including reduced adverse effects on sexual function26, and good tolerability in chronic obstructive pulmonary disease patients27. Zofenopril is a drug belonging to the angiotensin-converting enzyme (ACE) class which, since its discovery, has been widely used in the treatment of CV and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes and hypertension28. Comparative data from several clinical trials have shown that zofenopril is an effective and well tolerated drug for the treatment of hypertension, as well as for acute myocardial infarction29.
Efficacy of zofenopril in combination with amlodipine in patients with acute myocardial infarction: a pooled individual patient data analysis of four randomized, double-blind, controlled, prospective studies
Published in Current Medical Research and Opinion, 2018
Claudio Borghi, Stefano Omboni, Giorgio Reggiardo, Stefano Bacchelli, Daniela Degli Esposti, Ettore Ambrosioni
ACEIs are recommended even as early hospital care after NSTEMI, starting immediately and continuing indefinitely in patients with a left ventricular ejection fraction (LVEF) less than 40%, hypertension, diabetes mellitus, or stable chronic kidney disease9. Among calcium channel blockers, amlodipine has strong evidence to reduce CV events, with a good safety profile10. Amlodipine is a long-acting, lipophilic, third generation dihydropyridine CCB that inhibits calcium influx into vascular smooth muscle cells and myocardial cells, thus decreasing peripheral vascular resistance. Its gradual onset of action minimizes any reflex neuroendocrine activation10. Concomitant treatment with ACEIs and amlodipine has been deeply investigated, and many combinations are currently available as fixed dose tablets11–15. However, there is little evidence on the combined use of zofenopril and amlodipine. Zofenopril is a lipophilic, long-lasting ACEI with high potency and significant tissue selectivity. It has been tested in a large clinical trial program (Survival of Myocardial Infarction Long-Term Evaluation—SMILE Studies) where it has demonstrated its prognostic benefit in reducing the 1-year occurrence of major CV events after AMI, with a larger benefit than placebo and ramipril and a similar protective effect to lisinopril7,16–18. The wide population involved in these studies offers the opportunity to evaluate the prognostic value of zofenopril in numerous post-AMI therapeutic strategies. In this study, we would evaluate whether concomitant amlodipine may affect the efficacy of zofenopril and other ACEIs in reducing CV events after AMI.