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March 9, 2005

Antihypertensive Agents and Cardiovascular Events in Patients With Coronary Disease and Normal Blood Pressure

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(10):1187-1189. doi:10.1001/jama.293.10.1187-b

To the Editor: The CAMELOT study by Dr Nissen and colleagues1 found that while hard end points, defined as cardiovascular death or nonfatal myocardial infarction, were not different among the 3 study groups, amlodipine was more effective than enalapril or placebo at preventing soft end points such as hospitalization for angina. Among 4 large clinical trials that evaluated long-term risk reduction with the use of angiotensin-converting enzyme inhibitors in patients with angina,14 the results of CAMELOT are consistent with the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) trial but in contrast with the Heart Outcomes Prevention Evaluation (HOPE) trial and the European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA), which showed beneficial effects of angiotensin-converting enzyme inhibition. Of these studies, the CAMELOT patient population may consist of the lowest-risk group since the prevalence of prior myocardial infarction was less than 40%, in contrast with 52% to 64% in the other 3 trials. Furthermore, in this study coronary artery disease was defined as more than 20% stenosis by visual estimation, instead of more than 50% stenosis, which was the definition used in EUROPA and PEACE because of its association with myocardial ischemia.5

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