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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

Slide: 26 of 29

Analysis of Trials That Tested the Addition of an ACEI or an ARB to Standard Medical Therapy (SMT) Versus SMT Alone Close to a Revascularization Procedure

Overall, there was no significant clinical benefit to the addition of an ACEI or an ARB to standard medical therapy close to a revascularization procedure with regard to total mortality, cardiovascular mortality, nonfatal myocardial infarction, stroke, the composite of the previous three outcomes, atrial fibrillation, angina-related hospitalizations, or heart failure-related hospitalizations. The strength of this evidence was rated “low-moderate” in the comparative effectiveness review. Additionally, there was evidence of an increase in adverse events. The seven clinical trials assessed in this analysis revealed:

  • Hypotension increased 5.5% in the control group and 12% in those taking ACEIs.Additional revascularization procedures were needed in 11% of the patients who started an ACEI or an ARB close to a revascularization procedure and in 6% of those who initiated only standard medical therapy.