Efficacy and safety of angiotensin receptor blockers in older patients: a meta-analysis of randomized trials.
BACKGROUND
The efficacy and safety of angiotensin receptor blockers (ARBs) in the older population is unclear.


OBJECTIVE
To determine the efficacy and safety of ARBs in older patients.


METHODS
Randomized trials that compared ARBs to control and reported clinical outcomes in patients with a mean age of 65 years or older were included. Random-effects summary risk ratios (RRs) were constructed.


RESULTS
A total of 16 trials met our selection criteria, which yielded 113,386 patients. ARBs were associated with a marginal increased risk of all-cause mortality (RR: 1.03, 95% confidence interval (CI): 1.00-1.06, P = 0.05), a nonsignificant increased risk of myocardial infarction (RR: 1.04, 95% CI: 0.96-1.12, P = 0.36), a marginal reduction in heart failure hospitalization (RR: 0.86, 95% CI: 0.74-1.00, P = 0.06), and a significant reduction in the risk of stroke (RR: 0.93, 95% CI: 0.87-0.99, P = 0.03). ARBs were associated with an increased risk of acute kidney injury (RR: 1.48, 95% CI: 1.24-1.77, P < 0.001), hypotension (RR: 1.56, 95% CI: 1.24-1.97, P < 0.001), and hyperkalemia (RR: 1.57, 95% CI: 1.13-2.19, P = 0.008). On the sensitivity analysis including placebo-controlled trials, the risk of all-cause mortality was no longer significant (P = 0.2), while the remainder of the outcomes did not change.


CONCLUSIONS
In older patients, the benefit of ARBs compared with control was strongest for stroke reduction, with no (or weak) associations for all-cause mortality, myocardial infarction, and heart failure hospitalization. Benefit was offset by an increased risk of acute kidney injury, hypotension, and hyperkalemia. Thus, ARBs should be used with caution in older patients when clinically indicated.
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA;
Islam Y
IY
Elgendy
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA;
Tianyao
T
Huo
North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA.
Veronica
V
Chik
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA;
Carl J
CJ
Pepine
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA; North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA. anthony.bavry@va.gov.
Anthony A
AA
Bavry
D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000517:prevention & control*
D057911:Angiotensin Receptor Antagonists
angiotensin receptor blockers; blood pressure; elderly; heart failure; hypertension; meta-analysis.