ACE inhibitors vs ARBs in high-risk patients

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This is a pretty recent review of the comparative cardio-protective

effects of ACE inhibitors and ARBs, finding superior protection for

the ACE inhibitors based on studies performed to date.

Ann Pharmacother. 2005 Mar;39(3):470-80. Epub 2005 Feb 8.

Angiotensin receptor blockers versus ACE inhibitors: prevention of

death and myocardial infarction in high-risk populations.

Epstein BJ, Gums JG.

Department of Pharmacy Practice, College of Pharmacy, University of

Florida, 625 SW 4th Avenue, Gainesville, FL 32601-6430, USA.

epstein@...

OBJECTIVE: To determine, through a review of the medical literature,

whether there is adequate evidence to support the use of angiotensin

receptor blockers (ARBs) in place of angiotensin-converting enzyme

(ACE) inhibitors in high-risk populations, focusing on the

prevention of death and myocardial infarction (MI).

DATA SOURCES: Original investigations, reviews, and meta-analyses

were identified from the biomedical literature via a MEDLINE search

(1966-August 2004). Published articles were also cross-referenced

for pertinent citations, and recent meeting abstracts were searched

for relevant data.

STUDY SELECTION AND DATA EXTRACTION: All articles identified during

the search were evaluated. Preference was given to prospective,

randomized, controlled trials that evaluated major cardiovascular

endpoints and compared ARBs with ACE inhibitors, active controls, or

placebo.

DATA SYNTHESIS: The renin-angiotensin system plays a pivotal role in

the continuum of cardiovascular disease and represents a major

therapeutic target in the treatment of patients at risk for vascular

events. While ACE inhibitors have been definitively shown to prevent

death and MI, studies with ARBs in similar populations have not

reduced these endpoints. In clinical trials that enrolled patients

with heart failure, post-MI, diabetes, and hypertension, ARBs did

not prevent MI or prolong survival compared with ACE inhibitors,

other antihypertensives, or placebo.

CONCLUSIONS: ACE inhibitors and ARBs should not be considered

interchangeable, even among patients with a documented history of

ACE inhibitor intolerance. ARBs can be considered a second-line

alternative in such patients with the realization that they have not

been shown to prevent MI or prolong survival.

Publication Types:

Review

Review, Tutorial

PMID: 15701766 [PubMed - indexed for MEDLINE