Trandolapril in left ventricular dysfunction after myocardial infarction: focus on the TRACE study.

The new angiotensin-converting enzyme (ACE) inhibitor trandolapril has been the subject of a broad pharmacological and clinical development program. The active metabolite, trandolaprilat, has been found to have a high level of affinity for angiotensin-converting enzyme. Trandolapril has demonstrated potent ACE inhibition, a long plasma half-life and a high degree of lipophilicity. The drug has been used to treat patients with mild-to-moderate hypertension and congestive heart failure following myocardial infarction. In the former patients, a once-daily dosage of trandolapril has produced significant and long-lasting reductions in blood pressure and has reduced left ventricular hypertrophy. Trandolapril is one of a few ACE inhibitors with a mean trough:peak ratio of blood pressure reduction with once-daily administration of over 50%. In addition, studies in hypertensive patients have revealed still greater reductions in blood pressure when trandolapril is combined with the calcium antagonist verapamil. In patients with left ventricular dysfunction after myocardial infarction, the large TRACE trial showed that mortality was reduced and life expectancy increased with trandolapril treatment.