Key result
A review of trials indicates that ARBs, alone or combined with ACE inhibitors, show no mortality difference compared to ACE inhibitors alone, though combination therapy may reduce HF hospitalizations.
Why the study?
Do ARBs, alone or in combination with ACE inhibitors, reduce mortality and morbidity compared to ACE inhibitors alone or placebo in patients with or at high risk of heart failure?
Do ARBs, alone or in combination with ACE inhibitors, reduce mortality and morbidity compared to ACE inhibitors alone or placebo in patients with or at high risk of heart failure?
ARBs provide an alternative or adjunct to ACE inhibitors in heart failure management, with genetic profiling potentially offering more targeted future therapies.
ARBs offer equivalent mortality outcomes to ACE inhibitors; leaves open whether combination reduces HF hospitalizations in broader populations.
The renin-angiotensin system (RAS) plays an important role in the pathogenesis and worsening of heart failure (HF). Blocking this system with angiotensin converting enzyme (ACE) inhibitors in patients with HF and left ventricular dysfunction reduces mortality and morbidity and these drugs are currently recommended as standard therapy. A more recently developed class of drug, angiotensin receptor blockers (ARBs) block the RAS at the receptor level, and may therefore provide more complete blockade. ARBs, either singly or in combination with ACE inhibitors, are currently being compared to either ACE inhibitor therapy alone or to placebo in randomized trials of patients with or at high risk of developing HF. With respect to large trials published to date directly comparing ARB versus ACE inhibitor therapy, neither the Losartan Heart Failure Survival Study (ELITE II) nor the Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan (OPTIMAAL) found differences in mortality or morbidity between the treatment groups. As regards combination ARB/ACE inhibitor therapy versus ACE inhibitor therapy alone, one completed study, the Valsartan Heart Failure Trial (Val-HeFT), found no differences in mortality but a decrease in HF-related hospitalizations in the combined therapy group. Four additional long-term trials (VALIANT, CHARM, ONTARGET, and TRANSCEND) should complete the totality of evidence regarding the role of ARBs in the treatment of HF. Since genetic polymorphisms affecting drug metabolizing enzymes or drug receptors are known to influence responses to drugs, exploration of these effects on treatment responses to ARBs and ACE inhibitors may provide for more targeted treatment of HF.
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Hebert et al. (2003) conducted a review in Heart failure. Angiotensin receptor blockers (ARBs) and ACE inhibitors vs. ACE inhibitors alone or placebo was evaluated on Mortality and morbidity. A review of trials indicates that ARBs, alone or combined with ACE inhibitors, show no mortality difference compared to ACE inhibitors alone, though combination therapy may reduce HF hospitalizations.
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