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
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.
- Agency for Healthcare Research and Quality. Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews, Version 1.0 [Draft posted Oct. 2007]. Rockville, MD.
- Coleman CI, Baker WL, Kluger J, et al. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II-Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. Comparative Effectiveness Review No. 18. (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I.) Rockville, MD: Agency for Healthcare Research and Quality; October 2009.
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