Angiotensin-Receptor Blockade in Acute Myocardial Infarction — A Matter of Dose

Beta-blockers, angiotensin-converting–enzyme (ACE) inhibitors, and aldosterone antagonists have been shown to reduce the overall risk of death as well as the risk of major nonfatal cardiovascular events when they are administered to patients with acute myocardial infarction who also have left ventricular systolic dysfunction, clinical evidence of heart failure, or both.1,2 However, there remains a sizable subgroup of patients in whom clinical heart failure worsens despite optimal medical therapy after acute myocardial infarction. Relevant to this discussion is the observation that ACE inhibitors block only 13 percent of the total production of angiotensin II in the human heart3 because . . .