Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin II-receptor blockers (ARBs) have been shown to be of benefit in patients with heart failure, and in patients who have reduced ventricular function following a myocardial infarction.\u00a0 However, it is less well known whether they provide benefit in patients with ischaemic heart disease (IHD) and preserved ventricular function.\u00a0 Therefore the Agency for Healthcare Research and Quality commissioned this report to review the evidence for the clinical effects and harms of using ACE inhibitors, ARBs, or combination therapy in patients with IHD who are already receiving standard therapy.
\nThe authors reviewed 41 studies that met eligibility criteria.\u00a0 7 trials, including a total of 32,559 participants, concluded that ACE inhibitors reduced the relative risk (RR) for death (RR, 0.87) and nonfatal myocardial infarction (RR, 0.83), but increased the risk of syncope and cough.\u00a0 Low-strength evidence, suggested that ARBs reduce the RR for the composite endpoint of cardiovascular mortality, nonfatal myocardial infarction, or stroke (RR, 0.88).\u00a0 Moderate-strength evidence showed no overall benefit of the use of combination therapy on the risk of total mortality or myocardial infarction, when compared to using ACE inhibitors alone.\u00a0 Combination therapy did, however, lead to an increased risk of discontinuations due to hypotension (p<0.001) and syncope (p=0.035).
\nConclusions:
\nACE inhibitors reduce the risk of death, stroke, and myocardial infarction in patients with IHD and preserved ventricular function already on medical therapy; however there was little data to suggest that ARBs do so.\u00a0 The use of both classes of drugs in combination increased the risk of hypotension and syncope, with no additional clinical benefit compared to using ACE inhibitors alone.
\n\u2022 Baker WL, Coleman CL, Kluger J et al.\u00a0 Effectiveness of therapies for stable ischaemic heart disease.\u00a0 Systematic Reviews: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II\u2013Receptor Blockers for Ischemic Heart Disease.\u00a0 Annals Internal Med 2009, Oct 19.\u00a0 Epublication ahead of print.<\/p>\n","protected":false},"excerpt":{"rendered":"
Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin II-receptor blockers (ARBs) have been shown to be of benefit in patients with heart failure, and in patients who have reduced ventricular function following a myocardial infarction.\u00a0 However, it is less well known whether they provide benefit in patients with ischaemic heart disease (IHD) and preserved ventricular function.\u00a0 […]<\/p>\n