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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors or angiotensin II-receptor
William L Baker1, Craig I Coleman, Jeffrey Kluger
1University of Connecticut/Hartford Hospital Evidence-based Practice Center, 80 Seymour Street, Hartford, CT 06102, USA.
Annals of Internal Medicine
|December 17, 2009
Summary
Angiotensin-converting enzyme (ACE) inhibitors improve outcomes for patients with ischemic heart disease. Combination therapy offers no additional benefit and increases harms compared to ACE inhibitors alone.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ischemic heart disease (IHD) with preserved ventricular function leads to significant morbidity and mortality despite standard treatments.
- Identifying optimal medical therapies is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the benefits and harms of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or their combination therapy.
- Focus on adults with stable ischemic heart disease and preserved ventricular function.
Main Methods:
- Systematic review of MEDLINE, EMBASE, Cochrane Central Register, and Cochrane Database of Systematic Reviews.
- Inclusion of 41 trials with a minimum duration of 6 months, comparing ACE inhibitors, ARBs, or combination therapy against placebo or active control.
- Data extraction and quality assessment by two independent investigators.
Main Results:
- ACE inhibitors significantly reduce total mortality and nonfatal myocardial infarction compared to placebo, but increase risks of syncope and cough.
- Angiotensin II-receptor blockers (ARBs) showed a trend towards reducing a composite cardiovascular endpoint, with low-strength evidence.
- Combination therapy demonstrated no significant advantage over ACE inhibitors alone and was associated with increased risks of hypotension and syncope.
Conclusions:
- ACE inhibitor therapy improves outcomes in patients with stable ischemic heart disease and preserved ejection fraction.
- Evidence supporting ARB therapy is less robust.
- Combination therapy with ACE inhibitors and ARBs does not offer superior benefits and may increase adverse events.
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