We are in agreement with Fuchs in that blood pressure–lowering drugs should not be tested against placebo in patients with a clear indication for blood pressure reduction.
However, this is not the case with the PREAMI population.1 The PREAMI study enrolled elderly post–myocardial infarction patients with preserved left ventricular function (59%) and normal blood pressure (125/74 mm Hg). In 1998, when the PREAMI study started, there was no evidence of the benefits of ACE inhibition in this important subset of patients at higher risk for cardiovascular morbidity and mortality.
Ferrari R, PREAMI Investigators. It Is Time to Stop Comparing Blood Pressure–Lowering Drugs With Placebo—Reply. Arch Intern Med. 2006;166(16):1786-1787. doi:10.1001/archinte.166.16.1786-b