Meta-Analysis: Angiotensin-Receptor Blockers in Chronic Heart Failure and High-Risk Acute Myocardial Infarction

Lee, Victor C. S.; Rhew, David C.; Dylan, Michelle; Badamgarav, Enkhe; Braunstein, Glenn D.; Weingarten, Scott

doi:10.7326/0003-4819-141-9-200411020-00011

Cited by 178 publications

(104 citation statements)

References 46 publications

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“…ELITE II [7], the largest study to date comparing ACE inhibitors and ARBs in CHF using mortality as the primary endpoint, found that the two classes of drugs were similar in their reduction of mortality (hazard ratio comparing losartan to captopril 1.13, 95% confidence interval 0.95, 1.35). The findings of ELITE II were recently confirmed in a large meta-analysis comparing ARBs to ACE inhibitors (odds ratio for all-cause mortality 1.06, 95% confidence interval 0.90, 1.26) [6]. Similarly, two studies comparing an ARB to an ACE inhibitor after acute myocardial infarction failed to show superiority of the ARB.…”

Section: Discussionmentioning

confidence: 85%

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Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

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Background: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to improve survival in patients with congestive heart failure (CHF). We wish to determine whether there are sex-related differences in the optimal treatment of congestive heart failure. Methods: Using administrative databases, all patients N >= 65 years of age discharged with a diagnosis of CHF between January 1998 and March 2003 and who filled a prescription for an ARB or an ACE inhibitor within 90 days of discharge were identified. Time to all-cause death in women and men on ACE inhibitors or ARBs was compared. Results: There were 10,223 women (8627 ACE inhibitors and 1596 ARBs) and 9475 men (8484 ACE inhibitors and 991 ARBs). Hypertension was more common in women (50.1%) than men (33.1%). Women on ARBs had better survival than those on ACE inhibitors (adjusted hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.59, 0.80). There was no difference in survival in men prescribed ARBs compared to ACE inhibitors (HR 1.10, 95% CI 0.95, 1.30). Conclusion: These sex differences in treatment-related outcome are important but should be confirmed in a randomized trial before ARBs are preferentially prescribed to women with CHF.

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Section: Discussionmentioning

confidence: 85%

“…Several large clinical trials have clearly shown that ACE inhibitors [5] and angiotensin receptor blockers (ARBs) [6] improve survival in patients with CHF compared to placebo. In a head-to-head comparison, the improvement in survival in patients with CHF was comparable between losartan, an ARB, and captopril, an ACE inhibitor [7].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Hudson

Rahme

Behlouli

et al. 2007

European J of Heart Fail

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“…[1][2][3] However, randomized controlled trials (RCTs) have reported an increased risk of renal dysfunction among patients given combination therapy compared with patients given an ACE inhibitor or an angiotensinreceptor blocker alone (i.e., monotherapy). [4][5][6][7][8] It is not known whether the absolute risks of adverse renal outcomes would be the same in clinical practice as they are in RCTs.…”

mentioning

confidence: 99%

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

McAlister

Zhang²,

Tonelli³

et al. 2011

Canadian Medical Association Journal

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Research CMAJ Background:The risks associated with using an angiotensin-converting-enzyme (ACE) inhibitor and an angiotensin-receptor blocker together are unclear. This study was designed to determine the safety of combination therapy with these two drugs in clinical practice. Methods:We conducted a population-based longitudinal analysis using linked administrative and laboratory data for elderly patients who were new users of an ACE inhibitor, an angiotensin-receptor blocker or a combination of both medications between May 1, 2002, and Dec. 31, 2006. We compared outcomes in patients given combination therapy versus patients given monotherapy using Cox proportional hazards analyses with adjustment for baseline characteristics.Results: Of the 32 312 new users of either medication (mean age 76.1 years, median creatinine level 92 µmol/L), 1750 (5.4%) received combination therapy. However, 1512 (86.4%) of the patients who were given combination therapy did not have trial-established indications such as heart failure or proteinuria. Renal dysfunction was more common among patients given combination therapy (5.2 [95% confidence interval (CI) 3.4 to 7.9] events per 1000 patients per month) than among patients given monotherapy (2.4 [95% CI 2.2 to 2.7] events per 1000 patients per month) (adjusted hazard ratio [HR] 2.36, 95% CI 1.51 to 3.71). Hyperkalemia was also more common among patients given combination therapy (2.5 [95% CI 1.4 to 4.3] events per 1000 patients per month) than among patients given monotherapy (0.9 [95% CI 0.8 to 1.0] events per 1000 patients per month) (adjusted HR 2.42, 95% CI 1.36 to 4.32). Most patients took combination therapy for only a short time (median three months before at least one agent was stopped).Interpretation: Combination therapy was frequently prescribed for patients without established indications and was associated with an increased risk of adverse renal outcomes when compared with monotherapy. These results mirrored data from randomized controlled trials. Abstract

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“…In a recent meta-analysis, comparison of an ACE inhibitor and an angiotensin II receptor blockers in conditions of impaired cardiac function such as heart failure and postmyocardial infarction has not shown significant differences. 31 No difference in clinical outcomes has also been reported in other meta-analyses, 32,33 including the one that taking into account 25 trials involving a total of 68 711 patients at risk for coronary events, which showed that the odds ratio for a myocardial infarction associated with an angiotensin II receptor blockers was 1.03. 32 Nevertheless, another metaanalysis has reported that angiotensin II receptor blockers, which are beneficial on stroke and heart failure outcomes, may be less effective with regard to myocardial infarction.…”

Section: Angiotensin II Receptor Blockers Versus Ace Inhibitors On Hamentioning

confidence: 89%

Protective effects of renin–angiotensin blockade beyond blood pressure control

et al. 2009

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Meta-Analysis: Angiotensin-Receptor Blockers in Chronic Heart Failure and High-Risk Acute Myocardial Infarction

Abstract: Because ACE inhibitors and ARBs do not differ in efficacy for reducing all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and in patients with high-risk acute MI, ARBs should be regarded as suitable alternatives to ACE inhibitors.

Cited by 178 publications

References 46 publications

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

Protective effects of renin–angiotensin blockade beyond blood pressure control

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