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document
ACE inhibitors or AT-1 antagonists - which is OPTIMAAL after acute myocardial infarction ? OPTIMAAL ( Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan ) is the first major study to compare an angiotensin II Type 1 antagonist losartan ( Cozaar trade mark , Merck ) with an ACE inhibitor captonpril ( Capoten trade mark , Elan ) after myocardial infarction in patients with left ventricular dysfunction . Patients were assigned to a target dose of losartan 50 mg/day and captopril 50 mg t.i.d. , as tolerated . The primary end point was all-cause mortality and there were 499 ( 18 % ) and 447 ( 16 % ) deaths in the losartan and captopril group , respectively ( p = 0.07 ) . However , there were significantly more cardiovascular deaths with losartan ( 420 , 15 % ) than with captopril ( 363 , 13 % ; p = 0.03 ) . Losartan was better tolerated than captopril with fewer patients discontinuing medication ( 17 versus 23 % for losartan and captopril , respectively ) . In conclusion , if tolerated , captopril should remain the preferred treatment for patients after complicated acute myocardial infarction .
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Intervention_Pharmacological
ACE inhibitors
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Intervention_Pharmacological
AT-1 antagonists
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Intervention_Pharmacological
angiotensin II Type 1 antagonist losartan
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Intervention_Pharmacological
captonpril
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Intervention_Pharmacological
losartan
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Intervention_Pharmacological
captopril
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Intervention_Pharmacological
losartan
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Intervention_Pharmacological
captopril
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Intervention_Pharmacological
captopril
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Intervention_Pharmacological
Losartan
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Intervention_Pharmacological
captopril
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Intervention_Pharmacological
losartan
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Intervention_Pharmacological
captopril
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Intervention_Pharmacological
captopril
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Outcome_Mortality
all-cause mortality
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Outcome_Mortality
deaths
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Outcome_Physical
cardiovascular deaths
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Outcome_Other
tolerated
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Outcome_Mental
patients discontinuing medication
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Outcome_Physical
acute myocardial infarction
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Participant_Condition
myocardial infarction
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Participant_Condition
left ventricular dysfunction