Relative efficacy of angiotensin converting enzyme inhibitors on mortality of patients with congestive heart failure: implications of randomized trials and role of the aetiology (ischaemic or non-ischaemic) of heart failure.
We examined the influence of angiotensin converting enzyme inhibitors (ACE inhibitors) on mortality in patients with heart failure of both ischaemic or non-ischaemic origin. Eleven, randomized, placebo-controlled trials of ACE inhibitors involving 1266 patients were selected. The follow-up period varied from 3 to 6 months. Four different ACE inhibitors were used in the 11 clinical trials. A total of 679 patients presented with an ischaemic heart failure and 587 with a non-ischaemic heart failure. Meta-analysis, performed for both subgroups, showed that mortality was significantly decreased in the ischaemic subgroup only (ischaemic group: odds ratio 0.45; 95% confidence interval 0.28 to 0.71; non-ischaemic subgroup: odds ratio 0.7; 95% confidence interval 0.4 to 1.5). Although the two odds ratio are not significantly different, further randomized, placebo-controlled trials with ACE inhibitors are required in order to determine more precisely the benefit/risk ratio in patients with non-ischaemic heart failure.
Nony
P
P
Unité de Pharmacologie Clinique, Hôpital Cardiovasculaire et Pneumologique, Lyon, France.
Boissel
J P
JP
Girard
P
P
Leizorovicz
A
A
Lievre
M
M
Chifflet
R
R
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D004656:Enalapril / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D020913:Perindopril; D015996:Survival Rate
D000806:Angiotensin-Converting Enzyme Inhibitors; D007211:Indoles; D004656:Enalapril; D002216:Captopril; D020913:Perindopril