Inhibitors of angiotensin-converting enzyme, or ACE inhibitors, and angiotensin receptor blockers (ARBs), which are commonly used to treat high blood pressure, appear to be effective in treating stable ischemic heart disease, according to a new comparative-effectiveness review funded by the Agency for Healthcare Research and Quality (AHRQ). The analysis was posted online Oct. 20 in the Annals of Internal Medicine.
William L. Baker, PharmD, from the University of Connecticut, Hartford Hospital Evidence-based Practice Center in Hartford, Conn., and colleagues sought to compare benefits and harms of using ACE inhibitors, ARBs or combination therapy in adults with stable ischemic heart disease and preserved ventricular function.
Using standardized protocols, two independent investigators extracted information about study characteristics and rated the quality and strength of evidence from 41 studies.
According to the researchers, moderate- to high-strength evidence (seven trials; 32,559 participants) showed that ACE inhibitors reduce the relative risk (RR) for total mortality (RR, 0.87) and non-fatal MI (RR, 0.83), but increase the risk for syncope (RR, 1.24) and cough (RR, 1.67) compared with placebo.
The authors also noted that low-strength evidence (one trial; 5,926 participants) indicated that ARBs reduce the RR for the composite endpoint of cardiovascular mortality, nonfatal MI or stroke (RR, 0.88), but not for the individual components. Also, moderate-strength evidence (one trial; 25,620 participants) showed similar effects on total mortality (RR, 1.07) and MI (RR, 1.08), but an increased risk for discontinuations because of hypotension and syncope with combination therapy compared with ACE inhibitors alone.
However, the researchers generally found that “evidence about effects of ARBs was scant.”
Baker and colleagues concluded that ACE inhibitors reduce risk for mortality, stroke and MI in patients with stable ischemic heart disease and preserved left ventricular function who already receive standard treatments, such as beta blockers, statins and aspirin.