Angiotensin II receptor blockers significantly improved flow-mediated vasodilatation by 1.36% (95% CI 1.28-1.44) versus placebo, and were superior to CCBs, β-blockers, and diuretics.
Meta-Analysis
Estimación del efecto: Difference 1.36% (95% CI 1.28 to 1.44)
OBJECTIVE(S): Several studies have assessed the effect of angiotensin II receptor blockers (ARBs) on peripheral endothelial dysfunction as measured by flow-mediated vasodilatation (FMD), a widely-used indicator for endothelial function. We conducted a meta-analysis to investigate the effect in comparison to placebo or no treatment and other antihypertensives. METHODS: MEDLINE, Cochrane library and EMBASE were searched to September 2013 for randomized controlled trials (RCTs) that assessed the effect of ARBs versus placebo or no treatment and other antihypertensives (angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), β-blockers, diuretics) by forearm FMD. Furthermore, we also use meta-regression to analyze the relationship between the endothelial function and the duration of ARBs treatments. RESULTS: In 11 trials including 590 patients, ARBs (n = 315) significantly improved FMD (1.36%, 95% confidence internal CI:1.28 to 1.44) versus placebo or no treatment (n = 275). In 16 trials that included 1028 patients, ARBs (n = 486) had a significant effect (0.59%, 95% CI: 0.25 to 0.94) on FMD when compared with other antihypertensives (n = 542). In 8 trials, ARBs (n = 174) had no significant effect (-0.14%, 95% CI: -0.32 to 0.03) compared with ACEI (n = 173). Compared with others, the benefits of ARBs, respectively, were 1.67% (95% CI: 0.65 to 0.93) in 7 trials with CCBs, 0.79% (95% CI: 0.42 to 1.01) with β-blockers in 3 trials and 0.9% (95% CI: 0.77 to 1.03) with diuretics in 3 trials. Importantly, we found ARBs were less effective in a long time span (95% CI: -1.990 to -0.622) than the first 6 months (95% CI: -0.484 to 0.360). CONCLUSIONS: This study shows that ARBs improve peripheral endothelial function and are superior to CCBs, β-blockers and diuretics. However, the effect couldn't be maintained for a long time. In addition, there was no significant difference between ARBs and ACEI.
Li et al. (Mon,) conducted a meta-analysis in Peripheral endothelial dysfunction. Angiotensin II receptor blockers (ARBs) vs. Placebo, no treatment, or other antihypertensives (ACEIs, CCBs, β-blockers, diuretics) was evaluated on Peripheral endothelial function measured by flow-mediated vasodilatation (FMD) (Difference 1.36%, 95% CI 1.28 to 1.44). Angiotensin II receptor blockers significantly improved flow-mediated vasodilatation by 1.36% (95% CI 1.28-1.44) versus placebo, and were superior to CCBs, β-blockers, and diuretics.