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
Identifying Trade-offs for Your Patients: Summary of Results on Comparative Effectiveness of Adding ACEIs and/or ARBs to Standard Medical Therapy
The decision to add an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to the standard treatment regimen for patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function should be considered on a case-by-case basis by both the attending physician and the patient. This chart summarizes the benefits and harms associated with therapies that include ACEIs, ARBs, or both. For a detailed analysis of the benefits of adding an ACEI or ARB to standard medical therapy, see the complete comparative effectiveness review available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=335.
*In reviewing the benefits and harms listed in the table: An important point to consider is that while many of the trials included in these analyses reported harms data, adverse event reporting was not consistent across the trials. Additionally, several trials included a prerandomization run-in period, during which candidates who could not tolerate the trial drug were excluded. This may limit the applicability of the harms data to the entire IHD population. For specific details on trials that were evaluated, please refer to the original comparative effectiveness review, on which this slide talk is based (available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=334).
Note: Angioedema, a rare but potentially serious reaction, has been reported in several trials. Patients who are or may become pregnant while taking an ACEI or an ARB should be made aware of the risk of birth defects caused by these drugs.
This information is taken from the 2007 report, Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Antagonists (ARBS) for Treating Essential Hypertension, written by the Duke Evidence-Based Practice Center and funded by AHRQ. The report can be viewed at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=45&returnpage=.
- 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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