Combination ACE-Inhibitor and Angiotensin-Receptor Blocker Therapy: A Review of Safety Data

Angiotensin-converting–enzyme inhibitors and angiotensin-receptor blockers (ARBs) are effective treatments for heart failure (HF). However, persistently high rates of adverse outcomes despite treatment have generated interest in combining these drugs. Some study results suggest that such combination therapy reduces the risk for HF hospitalization despite no demonstrable evidence of reduced mortality. However, the safety of this approach is not well characterized.

Investigators analyzed randomized trials comparing combination therapy (an ACE inhibitor plus an ARB) with ACE inhibitor alone in patients with symptomatic left ventricular systolic dysfunction, either accompanying chronic HF or after acute MI. In the four studies with at least 500 …