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Ann Intern Med. 2004 Nov 2;141(9):693-704.

Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction.

Author information

  • 1Zynx Health Incorporated and Cedars-Sinai Health System, Los Angeles, California 90024, USA. vlee@zynx.com

Erratum in

  • Ann Intern Med. 2005 Mar 1;42(5):391. Dosage error in article text.

Abstract

BACKGROUND:

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.

PURPOSE:

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 SOURCES:

Data from original research published through 13 November 2003.

STUDY SELECTION:

Predefined criteria were used to identify 24 trials.

DATA EXTRACTION:

2 reviewers independently collected information on study characteristics and data on all-cause mortality and heart failure hospitalization.

DATA SYNTHESIS:

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.

LIMITATIONS:

Comparative economic data between ARBs and ACE inhibitors are lacking.

CONCLUSIONS:

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.

Comment in

PMID:
15520426
[PubMed - indexed for MEDLINE]
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