In reply
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.