The landscape after PEACE: do all ACE inhibitors act in an identical way?

ABSTRACT

The results of the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE trial), involving patients with stable coronary heart disease, demonstrated that the angiotensinconverting enzyme (ACE) inhibitor trandolapril did not reduce cardiovascular mortality, or the incidence of fatal or non-fatal myocardial infarction. These results were in conflict with the vast majority of previously published large-scale trials, and could be seen to weaken confidence in ACE inhibitor therapy of ischaemic heart disease.

This review article examines the results of PEACE in comparison with the other major trials in terms of the severity of the disease in the patients, the statistical power of the analyses, the doses of the agents used and the concept of a ‘class effect’ of the ACE inhibitors.

Key words: :

• ACE inhibitors
• Class effect
• Ischaemic heart disease
• Myocardial infarction, fatal, non-fatal
• PEACE trial