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Published on: February 17, 2011
Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction
Victor C Lee1, David C Rhew, Michelle Dylan
1Zynx Health Incorporated and Cedars-Sinai Health System, Los Angeles, California 90024, USA. vlee@zynx.com
Insights
Angiotensin-receptor blockers (ARBs) effectively reduce mortality and hospitalizations in chronic heart failure patients compared to placebo. ARBs show similar efficacy to angiotensin-converting enzyme (ACE) inhibitors for heart failure and high-risk myocardial infarction.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- The efficacy of angiotensin-receptor blockers (ARBs) in chronic heart failure and high-risk acute myocardial infarction (MI) remains a subject of debate.
- Recent clinical trials offer new insights into the role of ARBs in these patient populations.
Purpose of the Study:
- To evaluate the impact of ARBs versus placebo on mortality and heart failure hospitalizations.
- To compare ARBs with angiotensin-converting enzyme (ACE) inhibitors in managing chronic heart failure and high-risk acute MI.
- To assess the effectiveness of combined ARB and ACE inhibitor therapy.
Main Methods:
- A systematic review and meta-analysis of 24 randomized controlled trials published up to November 2003.
- Data extraction by two independent reviewers focusing on all-cause mortality and heart failure hospitalizations.
- Inclusion of 38,080 patients across chronic heart failure and high-risk acute MI cohorts.
Main Results:
- In chronic heart failure, ARBs significantly reduced all-cause mortality (OR, 0.83) and hospitalizations (OR, 0.64) versus placebo.
- No significant differences in all-cause mortality or hospitalizations were observed between ARBs and ACE inhibitors.
- Combination therapy with ARBs and ACE inhibitors reduced hospitalizations (OR, 0.77) but not all-cause mortality compared to ACE inhibitors alone.
- Limited data from two trials in high-risk acute MI showed no difference between ARBs and ACE inhibitors.
Conclusions:
- ARBs are effective alternatives to ACE inhibitors for patients with chronic heart failure and high-risk acute MI, showing comparable efficacy in reducing mortality and hospitalizations.
- Combination therapy may offer additional benefits in reducing heart failure hospitalizations.
- Further research is needed to explore the economic implications of using ARBs versus ACE inhibitors.
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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