Debate: angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers--a gap in evidence-based medicine

The American Journal of Cardiology
Stephen G Ball, William B White

Abstract

In this article, 2 leading physicians debate the strength of outcome data on the efficacy of angiotensin-converting enzyme (ACE) inhibitors versus angiotensin II receptor blockers (ARBs) for reducing the incidence of cardiovascular, cerebrovascular, and renovascular events. Dr. Stephen G. Ball notes that the efficacy of ACE inhibitors for reducing the risk for myocardial infarction independent of their effects on blood pressure is controversial. In the Heart Outcomes Prevention Evaluation (HOPE) study, ramipril treatment in high-risk patients was associated with a 20% reduction in the risk for myocardial infarction; mean reduction in blood pressure was 3 mm Hg for systolic blood pressure and 1 mm Hg for diastolic blood pressure. The HOPE investigators propose that the 20% reduction was much greater than would be expected based on the observed blood pressure reduction. However, a meta-regression analysis of blood pressure reduction in >20 antihypertensive therapy outcome trials found that the reduction in myocardial infarction risk with ramipril observed in HOPE was consistent with the modest blood pressure reduction seen with that agent. Nevertheless, there are convincing data for prevention of myocardial infarction with ACE in...Continue Reading

References

Jan 26, 1996·Science·U M ChandrasekharanA Husain
Jan 20, 2000·The New England Journal of Medicine·UNKNOWN Heart Outcomes Prevention Evaluation Study InvestigatorsG Dagenais
Mar 4, 2000·Lancet·M Burnier, H R Brunner
May 17, 2001·Current Hypertension Reports·R B Thakkar, S Oparil
Sep 22, 2001·The New England Journal of Medicine·E J LewisUNKNOWN Collaborative Study Group
Sep 22, 2001·The New England Journal of Medicine·B M BrennerUNKNOWN RENAAL Study Investigators
Sep 22, 2001·The New England Journal of Medicine·H H ParvingUNKNOWN Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group
Jan 5, 2002·The New England Journal of Medicine·J N CohnUNKNOWN Valsartan Heart Failure Trial Investigators
Jan 11, 2002·Lancet·P SleightUNKNOWN Heart Outcomes Prevention Evaluation (HOPE) Study
Feb 12, 2002·The American Journal of Cardiology·Thomas Unger
Feb 12, 2002·The American Journal of Cardiology·Michael A Weber

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Citations

Feb 3, 2005·Current Hypertension Reports·Mario Di Napoli, Francesca Papa
Jan 30, 2004·Internal Medicine Journal·P G Kerr
Apr 9, 2014·Cardiology Research and Practice·Jaspinder Kaur
Feb 27, 2004·Journal of the American Medical Directors Association·D UnnikrishnanT S Dharmarajan
Dec 8, 2004·Endocrine Reviews·Jennifer L Larsen
Jul 12, 2005·European Heart Journal·Gilles Montalescot, Jean-Philippe Collet
Jun 6, 2015·Critical Reviews in Food Science and Nutrition·Neetu Miglani, Kiran Bains
May 5, 2004·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Christy S CarterMarco Pahor
Dec 13, 2005·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Christy S CarterMarco Pahor
Dec 20, 2020·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Yasmina BourebabaLynda Bourebaba

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