Meta-Analysis: Angiotensin-Receptor Blockers in Chronic Heart Failure and High-Risk Acute Myocardial Infarction

Background: The role of angiotensin-receptor blockers (ARBs) in treating patients with chronic heart failure and high-risk acute myocardial infarction (MI) has been controversial, and recent clin- ical trials provide more information on this topic. Purpose: To quantify the effect of ARBs when compared with placebo (with and without background angiotensin-converting en- zyme (ACE) inhibitors) and ACE inhibitors on all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and high-risk acute MI. (OR), 0.83 (95% CI, 0.69 to 1.00)) and heart failure hospitaliza- tions (OR, 0.64 (CI, 0.53 to 0.78)) as compared with placebo; 2) for ARBs versus ACE inhibitors, all-cause mortality (OR, 1.06 (CI, 0.90 to 1.26)) and heart failure hospitalization (OR, 0.95 (CI, 0.80 to 1.13)) did not differ; 3) and for combinations of ARBs plus ACE inhibitors versus ACE inhibitors alone, all-cause mortality was not reduced (OR, 0.97 (CI, 0.87 to 1.08)) but heart failure hospital- izations were reduced (OR, 0.77 (CI, 0.69 to 0.87)). For patients with high-risk acute MI, 2 randomized trials compared ARBs with ACE inhibitors but did not reveal differences in all-cause mortality or heart failure hospitalization. Limitations: Comparative economic data between ARBs and ACE inhibitors are lacking. Conclusions: Because ACE inhibitors and ARBs do not differ in efficacy for reducing all-cause mortality and heart failure hospital- izations in patients with chronic heart failure and in patients with high-risk acute MI, ARBs should be regarded as suitable alterna- tives to ACE inhibitors.