Are ARBs as Safe and Effective as ACE Inhibitors?

Amanda Balbi

Angiotensin-receptor blockers (ARBs) are as safe and effective as angiotensin-converting-enzyme (ACE) inhibitors in treating patients without heart failure, according to a new study.

To conduct their study, researchers performed a meta-analysis of randomized trials from 1980 to 2015 and a sensitivity analysis of trials conducted after 2000. They compared ACE inhibitors and ARBs with placebos, active controls, and each other.
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Researchers tracked outcomes of all-cause mortality, cardiovascular death, myocardial infarction, angina, stroke, and more from 106 trials that included 254,301 patients without heart failure.

Results showed that ACE inhibitors but not ARBs decreased the rate of all-cause mortality, cardiovascular death, and myocardial infarction, as compared to placebo. However, after performing a sensitivity analysis of trials conducted after 2000, researchers found that ACE inhibitors and ARBs had similar results.

“In patients without heart failure, evidence from placebo-controlled trials (restricted to trials after 2000), active controlled trials, and head-to-head randomized trials all suggest ARBs to be as efficacious and safe as ACE [inhibitors], with the added advantage of better tolerability,” researchers concluded.

--Amanda Balbi

Reference:

Bangalore S, Fakheri R, Toklu B, et al. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients without heart failure? Insights from 254,301 patients from randomized trials.