ARB, ACE Inhibitor, or Both After MI in High-Risk Patients?

ACE inhibitors are well-established for limiting morbidity and mortality after MI, particularly in patients with LV dysfunction, heart failure, or both. To test the hypothesis that an angiotensin-receptor blocker (ARB), either alone or combined with an ACE inhibitor, is more effective than an ACE inhibitor alone in high-risk patients after MI, researchers conducted a manufacturer-funded randomized trial that compared precisely those 3 regimens.

A total of 14,703 adults with post-MI LV dysfunction or heart failure (mean ejection fraction, 35%) were randomized within 0.5 to 10 days of the index event to receive valsartan (target dosage, 160 mg twice daily); captopril (target dosage, 50 mg thrice daily); or both (target dosages: valsartan, 80 m…