Trandolapril is a long-acting ACE inhibitor used in hypertension and post–myocardial infarction patients with left ventricular dysfunction.

It has strong outcome data in post-MI populations.

Class: → ACE Inhibitors

• Inhibits Angiotensin-Converting Enzyme (ACE) • ↓ Angiotensin II • ↓ Aldosterone • ↑ Bradykinin

Net Effects: • ↓ Systemic vascular resistance (afterload) • Mild ↓ preload • ↓ Ventricular remodeling • ↓ Blood pressure

Mechanism identical to other ACE inhibitors.

• Prodrug → converted to active trandolaprilat • Long-acting (once-daily dosing) • Strong evidence in post-MI LV dysfunction (TRACE trial)

Less commonly prescribed today but pharmacologically solid.

• Effective once-daily ACE inhibitor

→ Hypertension Module

• Reduces mortality • Prevents ventricular remodeling

TRACE trial demonstrated survival benefit in patients with reduced EF after MI.

• Used similarly to other ACE inhibitors • Mortality benefit expected as class effect

→ Heart Failure Module

Hypertension: • Start: 1 mg once daily • Typical range: 1–4 mg once daily • Max: 4 mg daily

Post-MI: • Start low • Titrate as tolerated

Once-daily dosing.

• Prodrug → activated in liver • Renally cleared • Long half-life of active metabolite (~16–24 hours)

Dose adjustment required in renal impairment.

Class Effects: • Dry cough • Hyperkalemia • Hypotension • Angioedema (rare) • Mild creatinine elevation

No major differences from other ACE inhibitors.

Monitor: • Serum creatinine • Potassium

Check labs 1–2 weeks after initiation or dose changes.

• Pregnancy • History of ACE inhibitor–induced angioedema • Bilateral renal artery stenosis

✔ Long-acting ACE inhibitor ✔ Strong post-MI LV dysfunction data (TRACE) ✔ Once-daily dosing ✔ Less commonly prescribed today but evidence-based ✔ Same monitoring as all ACE inhibitors

Related:

→ ACE Inhibitors → Ramipril → Heart Failure Module → Return to CV Modules