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

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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 Nov 2;141(9):693-704. doi: 10.7326/0003-4819-141-9-200411020-00011.

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15520426 [ View in PubMed
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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.

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