General Cardiology

ACE and ARB in combination give no added benefits

Both ACE inhibitors and angiotensin II receptor blockers (ARBs) have been shown to benefit patients who have reduced ventricular function following a myocardial infarction. However, it is less well known whether they provide benefit to patients with ischaemic heart disease (IHD) and preserved ventricular function. Therefore the Agency for Healthcare Research and Quality commissioned this report to review the evidence for the clinical effects and harms of using ACE inhibitors, ARBs, or combination therapy in patients with IHD who are already receiving standard treatment.

The authors reviewed 41 studies that met eligibility criteria. Seven trials, including a total of 32 559 participants, concluded that ACE inhibitors reduced the RR for death (RR=0.87) and non-fatal myocardial infarction (RR=0.83), but increased the risk of syncope and cough. Low-strength evidence (1 trial, 5926 participants), suggested that ARBs reduce the RR for the composite end point of cardiovascular mortality, non-fatal myocardial infarction or stroke (RR=0.88). Moderate-strength evidence (1 trial, 25620 participants) showed no overall benefit of the use of combination therapy on the risk of total mortality or myocardial infarction, in comparison with using ACE inhibitors alone. Combination therapy did, however, lead to an …