Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients Without Heart Failure? Insights From 254,301 Patients From Randomized Trials

Mayo Clinic Proceedings
Sripal BangaloreFranz H Messerli

Abstract

To compare the efficacy and safety of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients without heart failure. Meta-analysis of randomized trials identified using PubMed, Embase, and Cochrane Central Register of Controlled Trials searches from January 1, 1980, through April 13, 2015, of ACEis and ARBs compared with placebo or active controls and corroborated with head-to-head trials of ARBs vs ACEis. Outcomes were all-cause mortality, cardiovascular death, myocardial infarction (MI), angina, stroke, heart failure, revascularization, and new-onset diabetes. Our search yielded 106 randomized trials that enrolled 254,301 patients. Compared with placebo, ACEis but not ARBs reduced the outcomes of all-cause mortality (ACEis vs placebo: relative risk [RR], 0.89; 95% CI, 0.80-1.00; ARBs vs placebo: RR, 1.01; 95% CI, 0.96-1.06; Pinteraction=.04), cardiovascular death (RR, 0.83; 95% CI, 0.70-0.99 and RR, 1.02; 95% CI, 0.92-1.14; Pinteraction=.05), and MI (RR, 0.83; 95% CI, 0.78-0.90 and RR, 0.93; 95% CI, 0.85-1.03; Pinteraction=.06). The meta-regression analysis revealed that the difference between ACEis and ARBs compared with placebo was due to a higher placebo event rate in the ACEis...Continue Reading

References

Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Sep 19, 2003·Lancet·K M Fox, UNKNOWN EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators
May 26, 2004·Statistics in Medicine·Julian P T Higgins, Simon G Thompson
Sep 19, 2006·The New England Journal of Medicine·UNKNOWN DREAM Trial InvestigatorsRury R Holman
Apr 2, 2008·The New England Journal of Medicine·UNKNOWN ONTARGET InvestigatorsCraig Anderson
Aug 30, 2008·The New England Journal of Medicine·Salim YusufUNKNOWN PRoFESS Study Group
Sep 9, 2008·Current Hypertension Reports·Donald G Vidt
Mar 11, 2011·The New England Journal of Medicine·Hermann HallerUNKNOWN ROADMAP Trial Investigators

❮ Previous
Next ❯

Citations

Sep 23, 2016·The New England Journal of Medicine·Eva M LonnSalim Yusuf
Oct 26, 2016·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Seema Patel
Mar 28, 2017·Current Opinion in Cardiology·Monica Ahluwalia, Sripal Bangalore
Nov 3, 2017·Journal of Hypertension·Louis HofstetterFranz H Messerli
Jan 19, 2018·Expert Review of Clinical Pharmacology·Julie Rask LarsenPeter Manu
Aug 18, 2017·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·Fadia MayyasAnan Jarab
May 31, 2018·Hypertension·Franz H MesserliEmrush Rexhaj
Sep 13, 2019·Heart Failure Reviews·Nicola Riccardo PuglieseStefano Taddei
Apr 10, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·François-Xavier LapébieVanina Bongard
Jan 20, 2017·The New England Journal of Medicine·David C Goff, William C Cushman
Jul 22, 2020·Pharmacological Reports : PR·Agnieszka Łoboda, Józef Dulak
May 13, 2017·High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension·F FiciG Grassi
Aug 23, 2019·Current Drug Targets·Khuraijam Dhanachandra Singh, Sadashiva S Karnik
Jul 11, 2020·Current Cardiology Reports·Jeffrey M Turner, Ravi Kodali
Aug 25, 2019·International Journal of Molecular Sciences·Tatyana A Meyers, DeWayne Townsend
Sep 23, 2016·The New England Journal of Medicine·Young-Hoon JeongSidney C Smith
Apr 30, 2021·The New England Journal of Medicine·Maurizio GallieniPaolo Fiorina
Apr 30, 2021·The New England Journal of Medicine·Salim YusufPrem Pais
Apr 30, 2021·The New England Journal of Medicine·Miguel Cainzos-Achirica
Oct 17, 2020·Future Cardiology·Sarah J Wang, Gary E Sander
Aug 28, 2021·Biomedicines·Francesca FortiniRoberto Ferrari
Sep 18, 2021·Cardiovascular Drugs and Therapy·Martin H StraussKrzysztof Narkiewicz
Sep 26, 2021·Journal of the Chinese Medical Association : JCMA·Chih-Wei ChenChun-Yao Huang

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiovascular Disease Pathophysiology

Cardiovascular disease involves several different processes that contribute to the pathological mechanism, including hyperglycemia, inflammation, atherosclerosis, hypertension and more. Vasculature stability plays a critical role in the development of the disease. Discover the latest research on cardiovascular disease pathophysiology here.

Cardiovascular Disorder in Diabetes

Diabetes is associated with an increased risk of cardiovascular disorders and heart failure. Discover the latest research here.