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Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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Results of Trials Evaluating the Addition of an ACEI or an ARB to Standard Therapy for Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

This slide summarizes the most pertinent results from the Comparative Effectiveness Review (CER) on the benefits and harms of adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy for stable ischemic heart disease with preserved left ventricular systolic function as compared to standard medical therapy alone or with a placebo. The next several slides will discuss these data in greater detail. When considered together, the benefits and harms of adding an ACEI or an ARB to standard medical therapy indicate that there may be a clinical benefit from such therapy for some patients with stable ischemic heart disease and preserved left ventricular systolic function (LVSF). However, the potential risks of cough, syncope, or hyperkalemia should be considered for each individual patient before adding an ACEI or an ARB to his or her treatment regimen.

Very few of the trials evaluated for the CER compared the addition of an ACEI or an ARB or both to an active control. Only two trials compared the addition of an ACEI or a calcium channel blocker to standard medical therapy (Nissen et al., 2004; Yiu et al., 2004). In both trials, the clinical benefits were similar between the two treatment arms, and there was some limited evidence that ACEIs may increase the risk for hypotension and cough. Additional trials are required to make any definitive clinical recommendations with regard to the addition of calcium channel blockers over ACEIs to standard medical therapy.

 

Cardiovascular events are the leading cause of death in patients treated with hemodialysis for chronic kidney disease. Among these patients, left ventricular hypertrophy is considered to be an ischemic heart disease equivalent, as defined by the National Kidney Foundation. In a clinical trial conducted by Zannad et al. (2006), however, there was no impact on cardiovascular mortality after fosinopril, an ACEI, was added to standard therapy for patients with end-stage renal disease and left ventricular hypertrophy.