The effects of angiotensin-receptor blockers on mortality and morbidity in heart failure: a systematic review.
BACKGROUND
Trials evaluating angiotensin-receptor blockers in heart failure (HF) have shown inconsistent results.


OBJECTIVE
To evaluate the effect of angiotensin II (AII) receptor blockers in HF patients on total mortality and HF hospitalisations.


METHODS
Systematic search of the literature through MEDLINE (1980-2007) and abstracts of major cardiovascular congresses from 2002 to 2007.


METHODS
(i) randomised controlled trials with more than 500 patients and follow up > 6 months, (ii) availability of total mortality and/or (iii) availability of hospital admission because of worsening HF. Data retrieved by two independent reviewers. DerSimonian random effects model was used.


RESULTS
Mortality data were available from 27,495 patients. When AII receptor blockers plus angiotensin-converting enzyme inhibitors (ACE-I) were compared with ACE-I in chronic HF trials, the relative risk (RR) for death was 0.98 (95% CI: 0.84-1.15). When AII receptor blockers were compared with ACE-I the RR for death was 1.06 (95% CI: 0.56-1.62). Similar results were found for postmyocardial infarction trials. The effects on hospital admission revealed a RR of 0.83 (95% CI: 0.71-0.97) and 1.09 (95% CI: 0.74-1.60) respectively.


CONCLUSIONS
Angiotensin II receptor blockers did not show any beneficial effect on mortality when used in combination with ACE-I or when compared with ACE-I alone. A 17% reduction in hospital admissions was observed.
Shibata
M C
MC
Epicore Centre, Division of Cardiology, University of Alberta, AB, Canada. marcelo.shibata@ualberta.ca
Tsuyuki
R T
RT
Wiebe
N
N
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004338:Drug Combinations