Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin Receptor Blockers:...

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Nephrology

Background:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are recommended for cardiovascular and renal protection.
• Comparative long-term effectiveness of ACE inhibitors versus ARBs on mortality is not well-established.

Purpose of the Study:

• To compare the long-term effectiveness of initiating ACE inhibitors versus ARBs on all-cause mortality and major adverse cardiovascular events.
• To provide evidence for optimal selection of angiotensin-aldosterone system inhibitors.

Main Methods:

• Multidatabase cohort study using UK Biobank and China Renal Data System.
• Target trial emulation framework with propensity score matching for new users of ACE inhibitors or ARBs.
• Primary outcome: 5-year all-cause mortality; Secondary outcome: major adverse cardiovascular events.

Main Results:

• ACE inhibitor initiation was associated with a higher risk of 5-year all-cause mortality (UK Biobank: HR 1.13; China Renal Data System: HR 1.12).
• Patients initiating ACE inhibitors showed a greater risk of major adverse cardiovascular events compared to ARB initiators in both databases.
• Consistent findings across both large-scale databases strengthen the study's conclusions.

Conclusions:

• Initiation of ACE inhibitors demonstrated higher risks for all-cause mortality and major adverse cardiovascular events compared to ARBs.
• Findings emphasize the need for careful consideration when selecting between ACE inhibitors and ARBs for patient care.
• This research contributes valuable insights into the comparative safety and effectiveness of these widely used drug classes.