Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials

Jong, Philip; Demers, Catherine; McKelvie, Robert S.; Liu, Peter P.

doi:10.1016/s0735-1097(01)01775-2

Cited by 136 publications

(54 citation statements)

References 29 publications

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“…Patients were in New York Heart Association functional classes II and III and had LVEF Ͻ0. 35. Both of these were digoxin discontinuation trials.…”

Section: Proved and Radiance Trialsmentioning

confidence: 99%

“…35 A more recent trial 36 also showed that ARBs were not superior to ACE-I in the treatment of heart failure or LV dysfunction after myocardial infarction. In the Randomized ALdactone (spironolactone) Evaluation Study for congestive heart failure (RALES) trial, 37 patients in the spironolactone group received digoxin (75%), diuretics (100%), ACE-I/ARB (95%), and ␤-blockers (11%).…”

Section: Advantages Of Digitalis Therapy In Clinical Hfmentioning

confidence: 99%

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Digitalis Therapy for Patients in Clinical Heart Failure

Rahimtoola

2004

Circulation

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“…Patients were in New York Heart Association functional classes II and III and had LVEF Ͻ0. 35. Both of these were digoxin discontinuation trials.…”

Section: Proved and Radiance Trialsmentioning

confidence: 99%

Section: Advantages Of Digitalis Therapy In Clinical Hfmentioning

confidence: 99%

Digitalis Therapy for Patients in Clinical Heart Failure

Rahimtoola

2004

Circulation

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“…While our results are restricted to patients with essential hypertension, the agents studied here have been compared in large studies and in systematic reviews for related conditions such as congestive heart failure, ischemic heart disease, and chronic kidney disease. 120,123,124 These systematic reviews, like ours, have limited inclusion to studies conducted in patients with the target condition; however, these reviews have examined an overlapping set of efficacy and safety outcomes. As a result,…”

Section: Study Namementioning

confidence: 99%

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

et al. 2011

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OBJECTIVES:A 2007 systematic review compared angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in patients with hypertension. Direct renin inhibitors (DRIs) have since been introduced, and significant new research has been published. We sought to update and expand the 2007 review. DATA SOURCES: We searched MEDLINE and EMBASE (through December 2010) and selected other sources for relevant English-language trials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included studies that directly compared ACE inhibitors, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of follow-up; and reported at least one outcome of interest. Ninety-seven (97) studies (36 new since 2007) directly comparing ACE inhibitors versus ARBs and three studies directly comparing DRIs to ACE inhibitor inhibitors or ARBs were included. STUDY APPRAISAL AND SYNTHESIS METHODS: A standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. RESULTS: In spite of substantial new evidence, none of the conclusions from the 2007 review changed. The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents, as well as for superiority of ARBs for short-term adverse events (primarily cough). However, the new evidence was insufficient on long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, and differences in key patient subgroups. LIMITATIONS: Included studies were limited by followup duration, protocol heterogeneity, and infrequent reporting on patient subgroups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects. Few, if any, of the questions that were not answered in the 2007 report have been addressed by the 36 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly. CLINICAL CASEA 54-year-old woman with a history of hypertension is seen by her doctor for persistently elevated blood pressure in spite of adherence to hydrochlorothiazide 25 mg daily. She is overweight and has a strong family history of coronary artery disease. To control her blood pressure, she and her doctor discuss adding an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin II receptor blocker (ARB), or a direct renin inhibitor (DRI) to her regimen. She is primarily interested in avoiding the cardiovascular complications of hypertension, but does not want to take medication more than once a day, and she is concerned about side effects and the cost of her medication. What information is available to help guide her decision?Electronic supplementary material The online version of this article

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“…17 However, a 17% reduction in hospital admissions, relative to placebo, was observed with the use of ARBs. 17,18 The current review had 3 specific objectives: to elucidate the reasons for conflicting data on the outcome of cancer incidence between the 3 meta-analyses, to understand the impact of outcome reporting bias on meta-analysis of clinical trials, and to describe the role that health care regulators could play in minimizing the occurrence of reporting bias.…”

Section: Introductionmentioning

confidence: 99%

Does Outcome Reporting Bias “Cause” Cancer? Risks Associated with Hidden Data on Angiotensin Receptor Blockers

Egan

Lee

Minhas³

et al. 2012

CJHP

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Conflicting reports have been published regarding the influence of angiotensin receptor blockers (ARBs) on the incidence of cancer. One meta-analysis reported a 1% absolute increase in the incidence of cancer associated with ARBs over 4 years. Contrasting findings were reported in an industry-sponsored meta-analysis and in another meta-analysis, both of which showed no difference in the incidence of cancer in ARB treatment groups relative to control groups. The US Food and Drug Administration has recently asserted that evidence does not support an association between ARBs and the development of cancer. The current review compares the 3 published meta-analyses assessing the association between ARBs and cancer and shows that outcome reporting bias contributed to the conflicting results. Given the prevalence of this form of bias in the scientific literature, the processes for systematic reviews and meta-analyses are under siege, and there is an important role for health care regulators to play. If all outcome data from clinical trials were to be reported in the public domain, independent analyses could be performed and the results of industry-sponsored trials verified. Furthermore, if regulators were to mandate the publication, in the public domain, of all clinical outcomes collected in clinical trials, outcome reporting bias could be eliminated. RÉSUMÉContexte : Des rapports contradictoires ont été publiés quant à l'influence des antagonistes des récepteurs de l'angiotensine (ARA) sur l'incidence du cancer. Une méta-analyse a signalé une augmentation absolue de 1 % de l'incidence du cancer associée aux ARA sur une période de quatre ans. Des résultats très différents issus de deux méta-analyses, dont l'une a été commanditée par l'industrie, n'ont montré aucune différence dans l'incidence du cancer dans les groupes traités par les ARA comparativement aux groupes témoins. La Food and Drug Administration des États-Unis a déjà affirmé que les données probantes ne corroborent pas le lien entre les ARA et l'apparition de cancer. La présente analyse compare les trois méta-analyses publiées évaluant le lien entre les ARA et le cancer, et montre que les biais de publication des résultats ont contribué à ces conclusions contradictoires. Étant donné la prévalence de cette forme de biais dans la littérature scientifique, la démarche entourant les analyses systématiques et les méta-analyses est sur la sellette et les organismes de réglementation des soins de santé ont un important rôle à jouer dans ce contexte. Si toutes les données issues des études cliniques étaient rendues publiques, des analyses indépendantes pourraient être effectuées et les résultats des études commanditées par l'industrie pourraient être vérifiés. En outre, si les organismes de réglementation exigeaient de rendre publiques l'ensemble des données issues des études cliniques, on pourrait alors éliminer les biais de publication des résultats.Mots clés : biais de publication des résultats, méta-analyse, antagonistes des récepteurs de l'angiotensine ...

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Angiotensin receptor blockers in heart failure: meta-analysis of randomized controlled trials

Cited by 136 publications

References 29 publications

Digitalis Therapy for Patients in Clinical Heart Failure

Digitalis Therapy for Patients in Clinical Heart Failure

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

Does Outcome Reporting Bias “Cause” Cancer? Risks Associated with Hidden Data on Angiotensin Receptor Blockers

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