• Victor C Lee, David C Rhew, Michelle Dylan, Enkhe Badamgarav, Glenn D Braunstein, and Scott R Weingarten.
• Zynx Health Incorporated and Cedars-Sinai Health System, Los Angeles, California 90024, USA. vlee@zynx.com
• Ann. Intern. Med. 2004 Nov 2; 141 (9): 693-704.

BackgroundThe role of angiotensin-receptor blockers (ARBs) in treating patients with chronic heart failure and high-risk acute myocardial infarction (MI) has been controversial, and recent clinical trials provide more information on this topic.PurposeTo quantify the effect of ARBs when compared with placebo (with and without background angiotensin-converting enzyme [ACE] inhibitors) and ACE inhibitors on all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and high-risk acute MI.Data SourcesData from original research published through 13 November 2003.Study SelectionPredefined criteria were used to identify 24 trials.Data Extraction2 reviewers independently collected information on study characteristics and data on all-cause mortality and heart failure hospitalization.Data Synthesis24 trials involving 38 080 patients were included. Analysis of chronic heart failure trials revealed that 1) ARBs were associated with reduced all-cause mortality (odds ratio [OR], 0.83 [95% CI, 0.69 to 1.00]) and heart failure hospitalizations (OR, 0.64 [CI, 0.53 to 0.78]) as compared with placebo; 2) for ARBs versus ACE inhibitors, all-cause mortality (OR, 1.06 [CI, 0.90 to 1.26]) and heart failure hospitalization (OR, 0.95 [CI, 0.80 to 1.13]) did not differ; 3) and for combinations of ARBs plus ACE inhibitors versus ACE inhibitors alone, all-cause mortality was not reduced (OR, 0.97 [CI, 0.87 to 1.08]) but heart failure hospitalizations were reduced (OR, 0.77 [CI, 0.69 to 0.87]). For patients with high-risk acute MI, 2 randomized trials compared ARBs with ACE inhibitors but did not reveal differences in all-cause mortality or heart failure hospitalization.LimitationsComparative economic data between ARBs and ACE inhibitors are lacking.ConclusionsBecause ACE inhibitors and ARBs do not differ in efficacy for reducing all-cause mortality and heart failure hospitalizations in patients with chronic heart failure and in patients with high-risk acute MI, ARBs should be regarded as suitable alternatives to ACE inhibitors.

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