Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure

a systematic review and meta-analysis

Toshio Ohtsubo, Rei Shibata, Hisashi Kai, Ryuji Okamoto, Eita Kumagai, Hiroaki Kawano, Akira Fujiwara, Takanari Kitazono, Toyoaki Murohara, Hisatomi Arima

研究成果: ジャーナルへの寄稿記事

1 引用 (Scopus)

抄録

Angiotensin-converting enzyme inhibitors (ACEIs) are considered primary drugs for the secondary prevention of myocardial infarction (MI), and angiotensin receptor blockers (ARBs) are used when ACEIs cannot be tolerated. However, it is unclear whether ACEIs or ARBs are more appropriate first-line drugs in hypertensive patients with MI or heart failure (HF). The present study aimed to compare the effects of ACEIs and those of ARBs in these patients. Sixty randomized controlled trails (RCTs) that compared the effects of ACEIs and ARBs in patients with MI or HF were extracted by searching PubMed/MEDLINE, Cochrane Database, and the Medical Central Journal database according to the PRISMA guidelines. We finally selected six eligible RCTs and identified three systematic reviews and meta-analyses. The proportion of hypertensive patients ranged from 36 to 69%. Meta-analyses were performed for recurrence or new onset of MI (risk ratio 0.97 [95% confidence interval: 0.88, 1.06]), hospitalization for HF (0.98 [0.84, 1.14]), cardiovascular or total mortality (0.98 [0.91, 1.05]), cardiovascular events or stroke (1.02 [0.94, 1.11]), and adverse events (1.40 [1.11, 1.77]). There were no significant differences between ACEIs and ARBs for all outcomes, except adverse events. Study discontinuation owing to adverse events was significantly more common with ACEIs than with ARBs. Among hypertensive patients with MI or HF, it appears desirable to select the most appropriate drugs, ACEIs or ARBs, in each case by considering the function level, patient background, comorbidity presence, blood pressure target, drug price and other such factors comprehensively in addition to considering tolerability.

元の言語英語
ページ(範囲)641-649
ページ数9
ジャーナルHypertension Research
42
発行部数5
DOI
出版物ステータス出版済み - 5 1 2019

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Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Meta-Analysis
Heart Failure
Myocardial Infarction
Pharmaceutical Preparations
Databases
Secondary Prevention
PubMed
MEDLINE
Comorbidity
Hospitalization
Stroke
Odds Ratio
Guidelines
Confidence Intervals
Blood Pressure
Recurrence
Mortality

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

これを引用

Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure : a systematic review and meta-analysis. / Ohtsubo, Toshio; Shibata, Rei; Kai, Hisashi; Okamoto, Ryuji; Kumagai, Eita; Kawano, Hiroaki; Fujiwara, Akira; Kitazono, Takanari; Murohara, Toyoaki; Arima, Hisatomi.

:: Hypertension Research, 巻 42, 番号 5, 01.05.2019, p. 641-649.

研究成果: ジャーナルへの寄稿記事

Ohtsubo, Toshio ; Shibata, Rei ; Kai, Hisashi ; Okamoto, Ryuji ; Kumagai, Eita ; Kawano, Hiroaki ; Fujiwara, Akira ; Kitazono, Takanari ; Murohara, Toyoaki ; Arima, Hisatomi. / Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure : a systematic review and meta-analysis. :: Hypertension Research. 2019 ; 巻 42, 番号 5. pp. 641-649.
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abstract = "Angiotensin-converting enzyme inhibitors (ACEIs) are considered primary drugs for the secondary prevention of myocardial infarction (MI), and angiotensin receptor blockers (ARBs) are used when ACEIs cannot be tolerated. However, it is unclear whether ACEIs or ARBs are more appropriate first-line drugs in hypertensive patients with MI or heart failure (HF). The present study aimed to compare the effects of ACEIs and those of ARBs in these patients. Sixty randomized controlled trails (RCTs) that compared the effects of ACEIs and ARBs in patients with MI or HF were extracted by searching PubMed/MEDLINE, Cochrane Database, and the Medical Central Journal database according to the PRISMA guidelines. We finally selected six eligible RCTs and identified three systematic reviews and meta-analyses. The proportion of hypertensive patients ranged from 36 to 69{\%}. Meta-analyses were performed for recurrence or new onset of MI (risk ratio 0.97 [95{\%} confidence interval: 0.88, 1.06]), hospitalization for HF (0.98 [0.84, 1.14]), cardiovascular or total mortality (0.98 [0.91, 1.05]), cardiovascular events or stroke (1.02 [0.94, 1.11]), and adverse events (1.40 [1.11, 1.77]). There were no significant differences between ACEIs and ARBs for all outcomes, except adverse events. Study discontinuation owing to adverse events was significantly more common with ACEIs than with ARBs. Among hypertensive patients with MI or HF, it appears desirable to select the most appropriate drugs, ACEIs or ARBs, in each case by considering the function level, patient background, comorbidity presence, blood pressure target, drug price and other such factors comprehensively in addition to considering tolerability.",
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AU - Kai, Hisashi

AU - Okamoto, Ryuji

AU - Kumagai, Eita

AU - Kawano, Hiroaki

AU - Fujiwara, Akira

AU - Kitazono, Takanari

AU - Murohara, Toyoaki

AU - Arima, Hisatomi

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