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The ACE inhibitor (ACEI) versus angiotensin-receptor blocker (ARB) controversy continues, with practice guidelines tending to resist recommending ARBs as an acceptable alternative. With data from recent, large, randomized ARB trials now in hand, researchers conducted a systematic review of the literature to assess outcomes with ARBs for patients with chronic heart failure (HF) or high-risk MI (i.e., MI complicated by HF).
The researchers identified 24 randomized trials (involving 38,080 patients) of ARB versus placebo, ARB versus ACEI, or ARB plus ACEI versus ACEI alone (there were no placebo-controlled trials for high-risk MI). The endpoints of primary interest were all-cause mortality and HF hospitalization.
For patients with chronic HF alo…