A Randomized Trial Comparing the Effect of Ramipril and Losartan in Survivors of ST-Elevation Myocardial Infarction

This study investigated the effect of 8 weeks of treatment with ramipril or losartan on N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels, plasminogen activator inhibitor-1 (PAI-1) activity, echocardiographic parameters and lipid profiles in patients after acute myocardial infarction (MI). Patients were randomly assigned to receive up to 10 mg/day ramipril (n = 27) or up to 100 mg/day losartan (n = 26). No significant differences in any of the tested variables were observed between the two treatment groups, either before or after treatment. Within the losartan-treated group a significant decrease in levels of NT-proBNP (211.1 +/- 211.5 versus 94.7 +/- 150.1 pg/ml), total cholesterol (5.7 +/- 1.0 versus 4.6 +/- 1.1 mmol/l), and low-density lipoprotein-cholesterol (3.5 +/- 0.9 versus 2.7 +/- 1.0 mmol/l) was observed after treatment compared with baseline. Thus, after an acute MI, losartan seems equal to ramipril in terms of the NT-proBNP levels, echocardiographic parameters, PAI-1 activity and lipid profiles that were achieved.