Myocardial Ischemia and Angiotensin-Converting Enzyme Inhibition

Mental stress provokes myocardial ischemia in many patients with stable coronary artery disease (CAD). Mental stress–induced myocardial ischemia (MSIMI) portends a worse prognosis, independent of standard cardiac risk factors or outcome of traditional physical stress testing. Angiotensin II plays a significant role in the physiological response to stress, but its role in MSIMI remains unknown. Our aim was to evaluate whether the use of angiotensin-converting enzyme inhibitors (ACEIs) is associated with a differential effect on the incidence of MSIMI compared with ischemia during physical stress.