These agents have effects beyond their simple hemodynamic benefits. Angiotensin-converting enzyme inhibitors influence the intravascular hemostatic environment to favor fibrinolysis (165) and improve endothelial function (166). The recent Heart Outcomes Prevention Evaluation (HOPE) study (167) found that treatment with ramipril significantly reduced the rates of acute myocardial infarction, stroke, and cardiac arrest in over 9000 patients with coronary and other vascular disease. A recent clinical study found that irbesartan, an antagonist of the angiotensin II type 1 receptor, significantly reduced levels of several substances recognized as markers of inflammation, which are elevated in patients with coronary artery disease (168).- Thus, angiotensin-converting enzyme inhibitors and related agents may also be considered as having a role in preventing the triggering of acute coronary disease.
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