Do ARBs reduce all-cause mortality and heart failure hospitalizations compared to placebo or ACE inhibitors in patients with chronic heart failure and high-risk acute MI?
ARBs demonstrate similar efficacy to ACE inhibitors for reducing all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and high-risk acute MI, making them suitable alternatives.
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.
Lee et al. (Tue,) studied this question.