The third Gruppo Italiano della Sopravvivenza nell'Infarcto Miocardico (GISSI-3) study (99) randomized 19,394 patients within 24 h of the onset of symptoms of AMI to the long-acting ACE inhibitor lisinopril (initial dose, 5 mg daily, titrated to 10 mg daily if tolerated) for 6 wk. A small (relative risk reduction of 12%, absolute risk reduction of 0.8%) but significant reduction (p = 0.03) in mortality was observed at 42 d after infarction only with lisinopril therapy (Fig. 7). Hypotension was the principal side effect, but it did not lead to adverse outcomes.

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