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Is Improved Survival a Class Effect of Angiotensin-Converting Enzyme Inhibitors?

Sean Hennessy, PharmD, PhD; and Stephen E. Kimmel, MD, MSCE
[+] Article, Author, and Disclosure Information

From University of Pennsylvania School of Medicine, Philadelphia, PA 19106.

Potential Financial Conflicts of Interest:Consultancies: S. Hennessy (consulting for a law firm representing Novartis in a matter unrelated to ACE inhibitors), S.E. Kimmel (consulting for Parke-Davis and Pfizer in matters unrelated to ACE inhibitors); Grants received: S. Hennessy (Pfizer [unrelated to ACE inhibitors]), S.E. Kimmel (Merck, Novartis, and Pfizer [unrelated to ACE inhibitors]).

Corresponding Author: Sean Hennessy, PharmD, PhD, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 803 Blockley Hall, Philadelphia, PA 19104-6021; e-mail, shenness@cceb.med.upenn.edu.

Current Author Addresses: Dr. Hennessy: Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 803 Blockley Hall, Philadelphia, PA 19104-6021.

Dr. Kimmel: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, 717 Blockley Hall, Philadelphia, PA 19104-6021.

Ann Intern Med. 2004;141(2):157-158. doi:10.7326/0003-4819-141-2-200407200-00016
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Randomized trials have shown that several but not all angiotensin-converting enzyme (ACE) inhibitors, when given at specific doses, increase survival in specific populations of patients with heart disease. Whether improved survival is a “class effect” of ACE inhibitors is a question of considerable clinical interest, and one that motivated the study by Pilote and colleagues in this issue (1). Clearly the answer to this question is not yet known, since the requisite head-to-head randomized trials have not been done. Unfortunately, such trials are not likely to be imminent because of the enormous size and expense of comparative trials of survival benefits of cardiovascular agents. How, then, should clinicians select an ACE inhibitor for survival benefit?

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