ARBs vs ACE Inhibitors For High-Risk Cardiac Patients

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Cardiovascular event incidence was lower in patients taking angiotensin receptor blockers (ARBs) vs angiotensin-converting enzyme inhibitors (ACEi).
Cardiovascular event incidence was lower in patients taking angiotensin receptor blockers (ARBs) vs angiotensin-converting enzyme inhibitors (ACEi).

Compared to ACE inhibitor (ACEi) use, treatment with angiotensin receptor blockers (ARB) appears to be associated with lower rates of cardiovascular (CV) events, especially in patients with established CV disease. Findings from this study were published in the journal Heart.

While both ACEis and ARBs are widely prescribed for patients with CV disease, the comparative effectiveness of these therapies in preventing CV events remained unclear. To compare the incidence of major CV events between users of these 2 drug classes, researchers analyzed the Reduction of Atherothrombosis for Continued Health registry, which included individuals with high cardiovascular risk. A total of 40,625 patients were included in the study (ACEIs 67.9% and ARBs 32.1%). The primary outcome of the study was rate of CV events (ie, CV death, non-fatal myocardial infarction, non-fatal stroke, CV disease-related hospitalization) at 4 years. 

Compared with ACEi use, the incidence of CV events was found to be lower in patients taking ARBs (33.4% vs 29.2%; adjusted HR: 0.90; 95% CI, 0.86–0.95; <.001). Cardiovascular mortality rates were also lower for the ARB group compared to the ACEi group;(6.9% vs 8.2%; HR: 0.83; 95% CI, 0.75–0.93; =.001). The same was true for all-cause mortality rates, 11.6% vs 12.6% (HR: 0.89; 95% CI, 0.82–0.97; =.005), for ARB compared to ACEi, respectively. 

The authors note that ARB use was associated with lower rates of all-cause mortality in secondary prevention, but not in primary prevention patients (=.03).

"Our results suggest that ARBs may provide superior protection against CV events than ACEIs in high-risk patients in real-world practice," the authors concluded.

Reference

Potier L, Roussel R, Elbez Y, et al; on behalf of the REACH Registry Investigators. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high vascular risk [published online March 11]. BMJ Heart. doi: 10/1136/heartjnl-2016-310705

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