Efficacy and safety of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and hyponatremia.

Abstract

BACKGROUND:

The presence of hyponatremia has been perceived to increase the risk of adverse events on initiation of treatment with angiotensin-converting enzyme inhibition in heart failure patients. The aim of this study was to investigate if baseline hyponatremia (plasma Na(+) <135 mmol/L) predicts development of hypotension and renal impairment in patients with myocardial infarction (MI) and left ventricular dysfunction (LVD) treated with angiotensin-converting enzyme inhibitors.

METHODS AND RESULTS:

A retrospective analysis was performed with data from the Trandolapril Cardiac Evaluation (TRACE) a double-blind randomized study. Plasma sodium levels were available in 1,731 patients, who were considered as the study population. Patients 3-7 days after MI with left LVD (LVEF ≤0.35), were randomized to trandolapril (n = 876) or placebo (n = 873). Baseline hyponatremia did not predict development of hypotension or worsening renal function after 1 month in patients treated with trandolapril compared with placebo (122 ± 19.1 mm Hg vs 123.2 ± 20.4 mm Hg [P = .84]; and creatinine clearance 57.4 ± 21.4 mL/min vs 55.2 ± 21.0 mL/min [P = .8]). There was no interaction between hyponatremia and the effect of trandolapril (P = .68).

CONCLUSIONS:

Mild hyponatremia was not a contraindication for the initiation of treatment with angiotensin-converting enzyme inhibitors in patients with post-MI heart failure.

• Authors: Louise Balling, Lars Kober, Morten Schou, Christian Torp-Pedersen, Finn Gustafsson
• Journal: Journal of cardiac failure (J Card Fail) Vol. 19 Issue 11 Pg. 725-30 (Nov 2013) ISSN: 1532-8414 [Electronic] United States
• PMID: 24263115 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Indoles
• trandolapril

Topics

• Aged
• Aged, 80 and over
• Angiotensin-Converting Enzyme Inhibitors (adverse effects, therapeutic use)
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Hyponatremia (drug therapy, mortality)
• Hypotension (chemically induced, diagnosis)
• Indoles (adverse effects, therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Retrospective Studies
• Survival Rate (trends)
• Treatment Outcome
• Ventricular Dysfunction, Left (drug therapy, mortality)