Benefit of ACE inhibitor treatment on age-related cardiovascular events: the emerging role of bradykinin

Angiotensin-converting enzyme inhibitors are now known to provide significant benefits in reducing cardiovascular events and survival by regulating the balance between bradykinin and angiotensin II.

In this study, a pooled analysis of three randomized trials ADVANCE, EUROPA, and PROGRESS, which included the ACE inhibitor Perindopril, was performed to determine the variability of treatment response as a function of age.

Among the 29,463 patients included in the trials, the mean age was 63 years with a large representation of populations younger than 60 years (9684 patients). Overall, the relative risk of cardiovascular death, non-fatal myocardial infarction and stroke was significantly reduced in patients receiving perindopril (HR 0.82, 95 % CI 0.76-0.88). Interestingly, the risk reduction was numerically greater in the younger groups of patients younger than 60 years: -28 % (HR 0.72, 95 % CI 0.62-0.83), -16 % in patients between 60 and 70 years (HR 0.84, 95 % CI 0.75-0.93) and older than 70 years -12 % (HR 0.88, 95 % CI 0.78-0.98.

Treatment with perindopril is associated with a significant reduction in major cardiovascular events that may be more pronounced in younger patients. Based on these preliminary findings, we hypothesize that the enhanced effect may be related to bradykinin conservation in younger populations.

Journal of Hypertension: September 2016 - Volume 34 - Issue - p e62 doi: 10.1097/01.hjh.0000491499.33701.25

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