A Cochrane review «Effect of early treatment with anti‐hypertensive drugs on short and long‐term mortality in patients with an acute cardiovascular event»1 «Perez MI, Musini VM, Wright JM. Effect of early treatment with anti-hypertensive drugs on short and long-term mortality in patients with an acute cardiovascular event. Cochrane Database Syst Rev 2009;»1 on effect of early treatment with ACE inhibitors (12 studies, n=84 456), beta-blockers (20), calcium channel blockers (CCBs) (18) and nitrates (18) on short and long-term mortality in patients with an acute cardiovascular event included 65 studies with a total of 166 206 subjects. Immediate ACE inhibitor treatment (started within 24 hours of the onset and lasting for maximum 2 days) was associated with a statistically non-significant reduction in all-cause mortality at 2 days (RR 0.91, 95% CI 0.82 to 1.00; 3 studies, n=77 414) and at 10 days (RR 0.68, 95% CI 0.12 to 3.98; 2 studies, n=145) in acute myocardial infarction. Short-term treatment (started within 24 hours of the onset and lasting for a maximum of 10 days) with ACE inhibitor was associated with a statistically significant reduction in all cause mortality at 10 days as compared to placebo (RR 0.93, 95% CI 0.87 to 0.98; 10 studies, n=84 311). No trial reported mortality at ≥ 30 days.
The 2023 ESC Guidelines for the management of acute coronary syndromes «Byrne RA, Rossello X, Coughlan JJ, ym. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44(38):3720-3826 »2 states that ACE inhibitors (or ARBs in cases of intolerance to ACE inhibitors) are recommended in acute coronary syndrome (ACS) patients with heart failure symptoms, LVEF ≤ 40%, diabetes, hypertension, and/or chronic kidney disease.