Victor C. Lee, MD; David C. Rhew, MD; Michelle Dylan, PhD; Enkhe Badamgarav, MD, MPH; Glenn D. Braunstein, MD; Scott R. Weingarten, MD, MPH
Acknowledgments: The authors thank Anacleto Gano Jr., MPH, for technical assistance in preparation of the manuscript and Cris Sevilla-Pappas for managing the reference database.
Grant Support: By a research grant from Cedars-Sinai Health System.
Potential Financial Conflicts of Interest: Stock ownership or options (other than mutual funds): D.C. Rhew (Merck, Pfizer); Grants received: Zynx Health Incorporated has received grants from AstraZeneca, Aventis, Bristol-Myers Squibb, Merck, Novartis, and Pfizer.
Requests for Single Reprints: Victor C. Lee, MD, Zynx Health Incorporated, 10880 Wilshire Boulevard, Suite 1450, Los Angeles, CA 90024; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Lee, Rhew, and Weingarten: Zynx Health Incorporated, 10880 Wilshire Boulevard, Suite 1450, Los Angeles, CA 90024.
Drs. Dylan and Badamgarav: Cerner Health Insights, 9100 Wilshire Boulevard, Suite 655E, Beverly Hills, CA 90212.
Dr. Braunstein: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.
The role of angiotensin-receptor blockers (ARBs) in treating patients with chronic heart failure and high-risk acute myocardial infarction (MI) has been controversial, and recent clinical trials provide more information on this topic.
To quantify the effect of ARBs when compared with placebo (with and without background angiotensin-converting enzyme [ACE] inhibitors) and ACE inhibitors on all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and high-risk acute MI.
Data from original research published through 13 November 2003.
Predefined criteria were used to identify 24 trials.
2 reviewers independently collected information on study characteristics and data on all-cause mortality and heart failure hospitalization.
24 trials involving 38 080 patients were included. Analysis of chronic heart failure trials revealed that 1) ARBs were associated with reduced all-cause mortality (odds ratio [OR], 0.83 [95% CI, 0.69 to 1.00]) and heart failure hospitalizations (OR, 0.64 [CI, 0.53 to 0.78]) as compared with placebo; 2) for ARBs versus ACE inhibitors, all-cause mortality (OR, 1.06 [CI, 0.90 to 1.26]) and heart failure hospitalization (OR, 0.95 [CI, 0.80 to 1.13]) did not differ; 3) and for combinations of ARBs plus ACE inhibitors versus ACE inhibitors alone, all-cause mortality was not reduced (OR, 0.97 [CI, 0.87 to 1.08]) but heart failure hospitalizations were reduced (OR, 0.77 [CI, 0.69 to 0.87]). For patients with high-risk acute MI, 2 randomized trials compared ARBs with ACE inhibitors but did not reveal differences in all-cause mortality or heart failure hospitalization.
Comparative economic data between ARBs and ACE inhibitors are lacking.
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.
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Lee VC, Rhew DC, Dylan M, Badamgarav E, Braunstein GD, Weingarten SR. Meta-Analysis: Angiotensin-Receptor Blockers in Chronic Heart Failure and High-Risk Acute Myocardial Infarction. Ann Intern Med. 2004;141:693-704. doi: 10.7326/0003-4819-141-9-200411020-00011
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Published: Ann Intern Med. 2004;141(9):693-704.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Coronary Risk Factors, Emergency Medicine.
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