Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Patients With Left Ventricular Systolic Dysfunction and Hyponatremia

• Published in: Journal of cardiac failure Vol. 19; no. 11; pp. 725 - 730
• Main Authors: Balling, Louise, MD, Kober, Lars, MD, DMSc, Schou, Morten, MD, PhD, Torp-Pedersen, Christian, MD, DMSc, Gustafsson, Finn, MD, PhD, DMSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2013
• Subjects: ACE-I; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cardiovascular; Double-Blind Method; Female; Follow-Up Studies; heart failure; Humans; hyponatremia; Hyponatremia - drug therapy; Hyponatremia - mortality; Hypotension - chemically induced; Hypotension - diagnosis; Indoles - adverse effects; Indoles - therapeutic use; Male; Middle Aged; Prospective Studies; Retrospective Studies; Survival Rate - trends; Treatment Outcome; Ventricular Dysfunction, Left - drug therapy; Ventricular Dysfunction, Left - mortality; ACE-I; heart failure; hyponatremia
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2013.09.004

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.