Role of Antihypertensives in Stable Heart Disease Studied

Angiotensin-converting enzyme inhibitors found to reduce death and heart attacks
By A. Agrawal, PhD
HealthDay Reporter

TUESDAY, Oct. 20 (HealthDay News) -- Patients with stable ischemic heart disease and preserved ventricular function may benefit from angiotensin-converting enzyme (ACE) inhibitors, according to a review published online Oct. 20 in the Annals of Internal Medicine.

William L. Baker, of Hartford Hospital in Connecticut, and colleagues reviewed the results of 41 trials that evaluated the efficacy and adverse effects of ACE inhibitors, angiotensin II-receptor blockers (ARBs), and combination therapy in individuals with stable ischemic heart disease and preserved ventricular function.

Considering the seven trials with moderate- to high-strength evidence involving 32,559 patients, the researchers found that ACE inhibitors were associated with a lower risk of total mortality and nonfatal myocardial infarction, but with an increased risk of syncope and cough compared with placebo. One trial of moderate strength evidence involving 25,620 patients showed that, compared with ACE inhibitors alone, treatment with ARBs plus ACE inhibitors was associated with a slightly higher risk of total mortality, myocardial infarction, and discontinuations due to hypotension and syncope.

"Adding an ACE inhibitor to standard medical therapy improves outcomes, including mortality and myocardial infarctions, in some patients with stable ischemic heart disease and preserved ventricular function," the authors conclude. "Combination therapy seems no better than ACE inhibitor therapy alone and increases harms."

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