2011 - Review: Angiotensin-receptor blockers do not increase adverse cardiovascular outcomes

Halim, Sharif A.; Newby, L. Kristin
August 2011
ACP Journal Club;8/16/2011, Vol. 155 Issue 2, p1
Academic Journal
Question Do angiotensin-receptor blockers (ARBs) increase risk for cardiovascular (CV) and other outcomes? Review scope Included studies compared ARBs with placebo or active control, had follow-up >1 year, enrolled >100 patients, and reported >1 of the following outcomes: angina pectoris, myocardial infarction (MI), heart failure, stroke, new-onset diabetes mellitus (DM), CV mortality, or all-cause mortality. Review methods PubMed, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (to Aug 2010); Food and Drug Administration dockets and meeting minutes; and reference lists were searched for randomized controlled trials (RCTs). 37 RCTs involving 39 comparisons (n =>147>020, mean age 29 to 76 y) met the selection criteria. 17 comparisons involved placebo, and 22 involved active comparators. Main results Meta-analyses showed that ARBs did not increase risk for angina pectoris, MI, CV mortality, or all-cause mortality (Table); similar results were found for comparisons of ARBs with placebo or with active comparators. ARBs reduced risk for stroke, heart failure, and new-onset DM (Table); a similar pattern was found for comparisons of ARBs with placebo. When compared with active comparators, ARBs reduced risk for heart failure and DM but not stroke (relative risk reduction 9%, 95% CI 4 to 20). Conclusion Angiotensin-receptor blockers do not increase risk for adverse cardiovascular outcomes and decrease risk for stroke, heart failure, and diabetes mellitus.


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