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December 15, 2009Annals of Internal Medicine

Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II–Receptor Blockers for Ischemic Heart Disease

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Why the study?

Do ACE inhibitors, ARBs, or combination therapy reduce mortality and myocardial infarction in adults with stable ischemic heart disease and preserved ventricular function?

Population

Adults with stable ischemic heart disease and preserved ventricular function (41 studies included)

Comparison

Angiotensin-converting enzyme inhibitors… vs Placebo or active control

Design

Systematic_review

Follow-up

at least 6 months

Authors

WBWilliam L. BakerNorthern Illinois University

Discussion

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Implication

Supports ACE inhibitor addition in stable IHD with preserved function; confirms mortality and nonfatal MI reductions in Level 1 evidence.

Structured PICO

Do ACE inhibitors, ARBs, or combination therapy reduce mortality and myocardial infarction in adults with stable ischemic heart disease and preserved ventricular function?

P
Population
Adults with stable ischemic heart disease and preserved ventricular function (41 studies included)
I
Intervention
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or combination therapy
C
Comparator
Placebo or active control
O
Outcome
Total mortality and nonfatal myocardial infarctionhard clinical

Adding an ACE inhibitor to standard medical therapy reduces mortality and myocardial infarctions in patients with stable ischemic heart disease and preserved ventricular function, whereas ARBs have less evidence of benefit and combination therapy increases harms without added benefit.

Limitations

  • Many studies either did not assess or did not report harms in a systematic manner
  • Many studies did not adequately report benefits or harms by various patient subgroups

Cite This Study

William L. Baker (2009) studied this question.

synapsesocial.com/papers/6a8249a4e35fc7ca402a5830https://doi.org/10.7326/0000605-200912150-00162
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of Nifedipine Retard with Angiotensin Converting Enzyme Inhibitors in Japanese Hypertensive Patients with Coronary Artery Disease: The Japan Multicenter Investigation for Cardiovascular Diseases-B (JMIC-B) Randomized Trial2004 · 145 citations
  2. 2Rationale and Design of a Large Study to Evaluate the Renal and Cardiovascular Effects of an ACE Inhibitor and Vitamin E in High-Risk Patients With Diabetes: The MICRO-HOPE Study1996 · 75 citations
  3. 3Angiotensin-Converting Enzyme Inhibitors in Coronary Artery Disease and Preserved Left Ventricular Systolic Function2006 · 162 citations
  4. 4The Angiotensin Converting Enzyme Inhibition Post Revascularization Study (APRES): Effects of Ramipril in Patients with Reduced Left Ventricular Function. Rationale, Design, Methods, Baseline Characteristics and First-Year Experience1998 · 8 citations
  5. 5Candesartan, an angiotensin II type-1 receptor blocker, reduces cardiovascular events in patients on chronic haemodialysis—a randomized study2006 · 206 citations