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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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Gaps in Knowledge About ACEIs and ARBs as Treatment for Stable Ischemic Heart Disease With Preserved Left Ventricular Systolic Function

In the trials that this Comparative Effectiveness Review (CER) was based on, only a few had detailed subanalyses of disease or patient characteristics that correlated with the improved patient outcomes derived from adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to the treatment regimen of patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function (LVSF). In addition, harms data were not available for many of the subpopulation analyses. Therefore, this evidence should be used mainly to generate hypotheses. From the subpopulation analyses, it is clear that more evidence is needed to determine whether there are patient characteristics or clinical factors that can determine whether patients with stable IHD and preserved LVSF will benefit more or less from the addition of an ACEI or an ARB to their standard therapies. Gender, diabetic status, the presence or absence of hypertension, the presence or absence of specific concomitant therapies, or a patient’s history of revascularization are all potential factors that may play a role in responsiveness to ACEIs or ARBs. Additional meta-analyses and clinical trials are needed to determine the benefits and harms of ACEIs and ARBs to these different subpopulations of patients.