A recent Cochrane review evaluated the efficacy of various antihypertensive drugs given within 24 hours of acute myocardial infarction. Compared to either placebo or no intervention, nitrates and angiotensin-converting enzyme (ACE) inhibitors were each associated with reductions in short-term all-cause mortality (level 1 [likely reliable] evidence). In an analysis of 82,624 patients from 6 trials, nitrates reduced the risk of death during the first 2 days (risk ratio 0.81, 95% CI 0.74-0.89). Assuming a baseline 2-day mortality of 2.3%, the NNT would be 168-396. Risk reduction after 10 days was similar. ACE inhibitors showed a trend toward reduced mortality at 2 days, and they significantly reduced 10-day mortality (risk ratio 0.93, 95% CI 0.87-0.98) in an analysis of 12 trials with 84,456 patients. For ACE inhibitors, the NNT was 146-944 (assuming 5.3% baseline 10-day mortality). Neither beta-blockers nor calcium channel blockers given during the first 24 hours were found to reduce all-cause mortality at 2, 10, or 30 days follow-up (Cochrane Database Syst Rev 2009 Oct 7;(4):CD006743).
For more information, see the ST-elevation myocardial infarction (STEMI) topic in DynaMed.