Sharif A. Halim, MD; L. Kristin Newby, MD, MHS
Do angiotensin-receptor blockers (ARBs) increase risk for cardiovascular (CV) and other outcomes?
Included studies compared ARBs with placebo or active control, had follow-up ≥ 1 year, enrolled ≥ 100 patients, and reported ≥ 1 of the following outcomes: angina pectoris, myocardial infarction (MI), heart failure, stroke, new-onset diabetes mellitus (DM), CV mortality, or all-cause mortality.
PubMed, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (to Aug 2010); Food and Drug Administration dockets and meeting minutes; and reference lists were searched for randomized controlled trials (RCTs). 37 RCTs involving 39 comparisons (n = 147 020, mean age 29 to 76 y) met the selection criteria. 17 comparisons involved placebo, and 22 involved active comparators.
Meta-analyses showed that ARBs did not increase risk for angina pectoris, MI, CV mortality, or all-cause mortality (Table); similar results were found for comparisons of ARBs with placebo or with active comparators. ARBs reduced risk for stroke, heart failure, and new-onset DM (Table); a similar pattern was found for comparisons of ARBs with placebo. When compared with active comparators, ARBs reduced risk for heart failure and DM but not stroke (relative risk reduction 9%, 95% CI −4 to 20).
Angiotensin-receptor blockers do not increase risk for adverse cardiovascular outcomes and decrease risk for stroke, heart failure, and diabetes mellitus.
Angiotensin-receptor blockers (ARBs) vs control in adults*
*CV = cardiovascular; MI = myocardial infarction; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a random-effects model.
Halim SA, Newby LK. Review: Angiotensin-receptor blockers do not increase adverse cardiovascular outcomes. Ann Intern Med. ;155:JC2–2. doi: 10.7326/0003-4819-155-4-201108160-02002
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Published: Ann Intern Med. 2011;155(4):JC2-2.
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