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Heart failure: is there a role for angiotensin II receptor blockers?
Insights
Angiotensin II receptor blockers (ARBs) show no superiority over angiotensin converting enzyme inhibitors (ACEIs) for heart failure (HF) mortality or hospitalization. ARBs may serve as an alternative for patients intolerant to ACEIs.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angiotensin II receptor blockers (ARBs) inhibit angiotensin II type 1 receptors, suppressing the renin-angiotensin-aldosterone system (RAAS).
- Six ARBs are approved in Canada for hypertension, but none for heart failure (HF).
Purpose of the Study:
- To evaluate the comparative efficacy of ARBs versus ACEIs in patients with heart failure.
- To assess the role of ARBs as an alternative or add-on therapy in HF management.
Main Methods:
- Systematic review and meta-analysis of 17 clinical trials comparing ARBs and ACEIs in HF patients.
- Analysis of studies investigating the addition of ARBs to ACEIs in HF.
Main Results:
- Meta-analysis of 17 trials found no evidence that ARBs are superior to ACEIs in reducing mortality or hospitalization in HF patients.
- Adding an ARB to an ACEI may reduce hospitalizations but not mortality, though the FDA found insufficient evidence for valsartan combination therapy.
Conclusions:
- ARBs are not superior to ACEIs for HF treatment regarding mortality or hospitalization.
- ARBs can be considered as an alternative for HF patients intolerant to ACEIs.
Abstract:
Angiotensin II receptor blockers (ARBs) directly inhibit the angiotensin II type 1 receptors, which suppresses the renin-angiotensin-aldosterone system (RAAS). Six ARBs are approved in Canada for the treatment of hypertension, none are yet approved for the treatment of heart failure (HF). Evidence comparing ARBs to angiotensin converting enzyme inhibitors (ACEIs) in HF is still limited. A recent meta-analysis of 17 clinical trials could not confirm that ARBs are superior to ACEIs in reducing either mortality or hospitalization in HF patients. ARBs may be used as an alternative in HF patients intolerant of ACEIs. A meta-analysis indicates that, compared to using an ACEI alone, adding an ARB to an ACEI carries the potential for additional benefits in terms of reduced hospitalization, but not mortality. However, the FDA determined there is currently insufficient evidence of such additional benefit when valsartan is combined to an ACEI in patients with HF.