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Review finds combining angiotensin receptor blockers with ACE inhibitors in heart failure may only benefit people with contraindications to β blockers
ARTICLE IN PRESS Evidence-based Cardiovascular Medicine (2004) 8, 241–242
Evidence- based
CARDIOVASCULAR MEDICINE www.elsevier.com/locate/ebcm
HEART FAILURE
Review finds combining angiotensin receptor blockers with ACE inhibitors in heart failure may only benefit people with contraindications to b blockers$ Abstracted from: Dimopoulos K, Salukhe TV, Coats AJ, et al. Meta-analyses of mortality and morbidity effects of an angiotensin receptor blocker in patients with chronic heart failure already receiving an ACE inhibitor (alone or with a betablocker). Int J Cardiol 2004; 93(2–3): 105–11.
Background The effect of combining ACE inhibitors and angiotensin receptor inhibitors remains uncertain in people with heart failure. Opinion is particularly divided over whether people receiving ACE inhibitors and b blockers should also receive angiotensin receptor inhibitors.
Objective This paper assessed the effects of adding angiotensin II receptor antagonists to ACE inhibitors, with and without b blockers, in people with symptomatic chronic heart failure. The endpoints were mortality, and mortality and morbidity combined.
failure; had mortality and morbidity as outcomes; and follow-up of at least 6 months. Four trials with 7666 participants were included.
Main results Combining angiotensin receptor inhibitors with ACE inhibitors reduced combined mortality and morbidity (odds ratio 0.89, 95% CI 0.81 to 0.98), but not mortality alone (odds ratio 0.97, 95% CI: 0.87 to 1.08). For people receiving b blockers, combining angiotensin receptor inhibitors and ACE inhibitors had no effect. In people not receiving b blockers, combining angiotensin receptor inhibitors and ACE inhibitors reduced combined mortality and morbidity (odds ratio 0.83; 95% CI 0.73 to 0.94), but not mortality alone (OR 0.93, 95% CI: 0.81 to 1.06).
Method The authors searched MEDLINE for double blind randomised trials available at October 2003. Eligible studies compared combined angiotensin receptor inhibitors and ACE inhibitors versus ACE inhibitors alone in people with symptomatic heart $
doi of associated Commentary: 10.1016/j.ebcm.2004.06.017
doi:10.1016/j.ebcm.2004.06.018
Authors’ conclusions Combining angiotensin receptor inhibitors with ACE inhibitors does not reduce adverse events in heart failure, apart from in people with contraindications to b blockers.
ARTICLE IN PRESS 242
Heart failure
Sponsored by: Individual authors were supported by the European Society of Cardiology, the Robert Luff Fellowship, and the British Heart Foundation
Overall quality topic importance method quality
Enquiries to K Dimopoulos: [email protected]
practical use Poor
Fair
Good
Excellent
Abstract provided by Debbie Singh.
Evidence- based
CARDIOVASCULAR MEDICINE www.elsevier.com/locate/ebcm
HEART FAILURE
Review finds combining angiotensin receptor blockers with ACE inhibitors in heart failure may only benefit people with contraindications to b blockers$ Abstracted from: Dimopoulos K, Salukhe TV, Coats AJ, et al. Meta-analyses of mortality and morbidity effects of an angiotensin receptor blocker in patients with chronic heart failure already receiving an ACE inhibitor (alone or with a betablocker). Int J Cardiol 2004; 93(2–3): 105–11.
Background The effect of combining ACE inhibitors and angiotensin receptor inhibitors remains uncertain in people with heart failure. Opinion is particularly divided over whether people receiving ACE inhibitors and b blockers should also receive angiotensin receptor inhibitors.
Objective This paper assessed the effects of adding angiotensin II receptor antagonists to ACE inhibitors, with and without b blockers, in people with symptomatic chronic heart failure. The endpoints were mortality, and mortality and morbidity combined.
failure; had mortality and morbidity as outcomes; and follow-up of at least 6 months. Four trials with 7666 participants were included.
Main results Combining angiotensin receptor inhibitors with ACE inhibitors reduced combined mortality and morbidity (odds ratio 0.89, 95% CI 0.81 to 0.98), but not mortality alone (odds ratio 0.97, 95% CI: 0.87 to 1.08). For people receiving b blockers, combining angiotensin receptor inhibitors and ACE inhibitors had no effect. In people not receiving b blockers, combining angiotensin receptor inhibitors and ACE inhibitors reduced combined mortality and morbidity (odds ratio 0.83; 95% CI 0.73 to 0.94), but not mortality alone (OR 0.93, 95% CI: 0.81 to 1.06).
Method The authors searched MEDLINE for double blind randomised trials available at October 2003. Eligible studies compared combined angiotensin receptor inhibitors and ACE inhibitors versus ACE inhibitors alone in people with symptomatic heart $
doi of associated Commentary: 10.1016/j.ebcm.2004.06.017
doi:10.1016/j.ebcm.2004.06.018
Authors’ conclusions Combining angiotensin receptor inhibitors with ACE inhibitors does not reduce adverse events in heart failure, apart from in people with contraindications to b blockers.
ARTICLE IN PRESS 242
Heart failure
Sponsored by: Individual authors were supported by the European Society of Cardiology, the Robert Luff Fellowship, and the British Heart Foundation
Overall quality topic importance method quality
Enquiries to K Dimopoulos: [email protected]
practical use Poor
Fair
Good
Excellent
Abstract provided by Debbie Singh.