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Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials
Philip Jong1, Catherine Demers, Robert S McKelvie
1Heart & Stroke/Richard Lewar Centre of Excellence, Division of Cardiology, University Health Network, University of Toronto, Toronto, Canada.
Insights
Angiotensin receptor blockers (ARBs) did not significantly reduce mortality or hospitalization in heart failure (HF) patients compared to placebo or ACE inhibitors. However, ARBs showed promise as monotherapy or in combination with ACE inhibitors.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Uncertainty exists regarding the effectiveness of angiotensin receptor blockers (ARBs) in heart failure (HF) treatment.
- ARBs' role as a substitute or adjunctive therapy to angiotensin-converting enzyme inhibitors (ACEIs) requires clarification.
Purpose of the Study:
- To evaluate the impact of angiotensin receptor blockers (ARBs) on mortality and hospitalization rates in patients diagnosed with heart failure (HF).
Main Methods:
- A meta-analysis was performed on randomized controlled trials.
- Included trials compared ARBs against placebo or ACEIs in symptomatic HF patients.
- Pooled outcomes focused on all-cause mortality and HF-related hospitalizations.
Main Results:
- Seventeen trials with 12,469 patients were analyzed.
- ARBs did not demonstrate superiority over controls for mortality (OR 0.96) or hospitalization (OR 0.86).
- Combination therapy with ARBs and ACEIs significantly reduced hospitalization (OR 0.74) but not mortality (OR 1.04).
Conclusions:
- This meta-analysis does not confirm ARBs' superiority in reducing mortality or HF hospitalizations in symptomatic HF patients.
- ARBs may offer benefits as monotherapy (without ACEIs) or in combination with ACEIs.
- Further research is warranted to fully elucidate the role of ARBs in HF management.
Objectives:
We sought to determine the effect of angiotensin receptor blockers (ARBs) on mortality and hospitalization in patients with heart failure (HF).
Background:
There is uncertainty regarding the efficacy of ARBs as substitute or adjunctive therapy to angiotensin-converting enzyme inhibitors (ACEIs) in the treatment of HF.
Methods:
We conducted a meta-analysis of all randomized controlled trials that compared ARBs with either placebo or ACEIs in patients with symptomatic HF. The pooled outcomes were all-cause mortality and hospitalization for HF.
Results:
Seventeen trials involving 12,469 patients were included. Overall, ARBs were not superior to controls in the pooled rates of death (odds ratio: 0.96; 95% confidence interval: 0.75 to 1.23) or hospitalization (0.86; 0.69 to 1.06). Stratified analysis, however, showed a non-significant trend in benefit of ARBs over placebo in reducing mortality (0.68; 0.38 to 1.22) and hospitalization (0.67; 0.29 to 1.51) when given in the absence of background ACEI therapy. When compared directly with ACEIs, ARBs were not superior in reducing either mortality (1.09; 0.92 to 1.29) or hospitalization (0.95; 0.80 to 1.13). In contrast, the combination therapy of ARBs and ACEIs was superior to ACEIs alone in reducing hospitalization (0.74; 0.64 to 0.86) but not mortality (1.04; 0.91 to 1.20).
Conclusions:
This meta-analysis cannot confirm that ARBs are superior in reducing all-cause mortality or HF hospitalization in patients with symptomatic HF, particularly when compared with ACEIs. However, the use of ARBs as monotherapy in the absence of ACEIs or as combination therapy with ACEIs appears promising.