Key result
Angiotensin II receptor blockers did not reduce mortality when added to ACE-I (RR 0.98; 95% CI 0.84-1.15) or compared with ACE-I alone (RR 1.06; 95% CI 0.56-1.62) in heart failure patients.
Why the study?
Do angiotensin II receptor blockers reduce mortality and heart failure hospitalizations in patients with heart failure when compared to or added to ACE inhibitors?
Systematic Review (n=27,495)
Do angiotensin II receptor blockers reduce mortality and heart failure hospitalizations in patients with heart failure when compared to or added to ACE inhibitors?
Effect estimate: RR 0.98 (95% CI 0.84-1.15)
In patients with heart failure, adding angiotensin II receptor blockers to ACE inhibitors does not reduce mortality but significantly reduces heart failure hospitalizations by 17%.
ARBs add no mortality benefit to ACE-I in HF; confirms ACE-I monotherapy suffices for survival in meta-analyses.
BACKGROUND: Trials evaluating angiotensin-receptor blockers in heart failure (HF) have shown inconsistent results. OBJECTIVE: To evaluate the effect of angiotensin II (AII) receptor blockers in HF patients on total mortality and HF hospitalisations. METHODS: Systematic search of the literature through MEDLINE (1980-2007) and abstracts of major cardiovascular congresses from 2002 to 2007. ELIGIBILITY CRITERIA: (i) randomised controlled trials with more than 500 patients and follow up > 6 months, (ii) availability of total mortality and/or (iii) availability of hospital admission because of worsening HF. Data retrieved by two independent reviewers. DerSimonian random effects model was used. RESULTS: Mortality data were available from 27,495 patients. When AII receptor blockers plus angiotensin-converting enzyme inhibitors (ACE-I) were compared with ACE-I in chronic HF trials, the relative risk (RR) for death was 0.98 (95% CI: 0.84-1.15). When AII receptor blockers were compared with ACE-I the RR for death was 1.06 (95% CI: 0.56-1.62). Similar results were found for postmyocardial infarction trials. The effects on hospital admission revealed a RR of 0.83 (95% CI: 0.71-0.97) and 1.09 (95% CI: 0.74-1.60) respectively. CONCLUSION: Angiotensin II receptor blockers did not show any beneficial effect on mortality when used in combination with ACE-I or when compared with ACE-I alone. A 17% reduction in hospital admissions was observed.
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Shibata et al. (2008) conducted a systematic review in Heart failure (n=27,495). Angiotensin II receptor blockers vs. ACE inhibitors was evaluated on Total mortality (RR 0.98, 95% CI 0.84-1.15). Angiotensin II receptor blockers did not reduce mortality when added to ACE-I (RR 0.98; 95% CI 0.84-1.15) or compared with ACE-I alone (RR 1.06; 95% CI 0.56-1.62) in heart failure patients.
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