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Published on: December 23, 2014
Do angiotensin II receptor blockers increase the risk of myocardial infarction?
Paolo Verdecchia1, Fabio Angeli, Roberto Gattobigio
1Dipartimento Malattie Cardiovascolari, Ospedale R. Silvestrini, 06100 Perugia, Italy. verdec@tin.it
Insights
Angiotensin receptor blockers (ARBs) do not increase the risk of myocardial infarction (MI). A meta-analysis found no excess MI risk with ARBs compared to placebo or ACE-inhibitors, supporting their safety profile.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Background:
- Safety concerns regarding Angiotensin Receptor Blockers (ARBs) emerged due to studies suggesting an increased risk of myocardial infarction (MI).
- Existing evidence created uncertainty about the cardiovascular safety of ARBs.
Purpose of the Study:
- To evaluate the association between Angiotensin Receptor Blockers (ARBs) and the risk of myocardial infarction (MI).
- To clarify the safety profile of ARBs in cardiovascular outcomes.
Main Methods:
- A meta-analysis of randomized clinical trials was conducted.
- Trials compared ARBs against placebo or other active drugs, excluding ARBs.
- Subgroup analyses were performed to assess MI incidence and cardiovascular mortality.
Main Results:
- Overall, ARBs were not associated with an excess risk of MI compared to placebo or ACE-inhibitors.
- MI incidence did not significantly differ between ARBs and placebo (OR: 0.96) or ACE-inhibitors (OR: 0.99).
- Cardiovascular mortality was not different between ARBs and other drug classes, and was slightly lower than placebo (OR: 0.91).
Conclusions:
- The study findings do not support the hypothesis that ARBs increase the risk of MI.
- ARBs appear to have a favorable safety profile regarding myocardial infarction.
- Further investigation into specific drug classes compared to ARBs may be warranted.
Aims:
The uncertainty surrounding safety of angiotensin receptor blockers (ARBs) increased after publication of experimental and clinical studies which suggested an excess risk of myocardial infarction (MI) in people treated with ARBs.
Methods And Results:
We performed a meta-analysis of randomised clinical trials, which compared ARBs with either a placebo or active drugs different from ARBs. Overall, ARBs were not associated with an excess risk of MI [odds ratio (OR): 1.03 in a random-effect model and 1.02 in a fixed-effect model]. In pre-specified subgroup analyses, incidence of MI did not differ between ARBs and either placebo (OR: 0.96; 95% CI: 0.84-1.10) or angiotensin-converting enzyme (ACE)-Inhibitors (OR: 0.99; 95% CI: 0.91-1.07). Incidence of MI was slightly higher with ARBs than with drug classes different from ACE-Inhibitors (OR: 1.16; P=0.06 in a random-effect model and 0.017 in a fixed-effect model). Cardiovascular mortality did not differ between ARBs and drugs different from ARBs (OR: 1.00 in a random-effect model and 0.99 in a fixed-effect model) and it was slightly lesser with ARBs than with placebo (OR: 0.91; 95% CI: 0.83-0.99; P=0.042) in a pre-specified subgroup analysis.
Conclusion:
Our findings do not support the hypothesis that ARBs increase the risk of MI.
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