This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsuyuki, R. T. Articles by McDonald, M. A. Search for Related Content PubMed PubMed Citation Articles by Tsuyuki, R. T. Articles by McDonald, M. A. Related Collections Health policy and outcome research Congestive Clinical Studies Acute myocardial infarction

(Circulation. 2006;114:855-860.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Angiotensin Receptor Blockers Do Not Increase Risk of Myocardial Infarction

Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP; Michael A. McDonald, MD, FRCP(C)

From EPICORE Centre, Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Correspondence to Dr Ross T. Tsuyuki, Professor of Medicine, EPICORE Centre, Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, 220 College Plaza, University of Alberta Campus, Edmonton, Alberta, Canada T6G 2C8. E-mail ross.tsuyuki@ualberta.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors has been well established; these agents have shown an overwhelming and unequivocal benefit in placebo-controlled trials across a spectrum of patients at risk for cardiovascular events.^1–9 What has been less clear, however, is whether inhibition of the renin-angiotensin-aldosterone system with angiotensin receptor blockers (ARBs) yields benefits of comparable scale. ARBs selectively inhibit the angiotensin II type 1 receptor, and it is axiomatic that this might offer theoretical advantages over ACE inhibitors by preventing the effects of angiotensin II generated by non–ACE-dependent pathways.^10–12 In large-scale clinical trials, ARBs have been shown to effectively lower blood pressure,^13–15 prevent progression to renal failure in patients with diabetes mellitus and proteinuria,^16–18 and reduce the incidence of major cardiac events in patients with heart failure.^19,20 These medications are also better tolerated than ACE inhibitors and are recommended in the American College of Cardiology/American Heart Association guidelines for patients with chronic heart failure or left ventricular dysfunction after myocardial infarction (MI) who are unable to tolerate ACE inhibitors and by the 2006 Canadian Cardiovascular Society consensus conference recommendations on heart failure.^21–23

Response by Strauss and Hall p 860

Debate has surfaced recently on the relative safety of ARBs with respect to MI. In a controversial editorial in the British Medical Journal,²⁴ Verma and Strauss drew attention to results from certain individual trials and concluded that ARBs increase MI, and they suggested that patients may need to be informed of these risks. Although supported by some,²⁵ many . . . [Full Text of this Article]

This article has been cited by other articles:

				M. Hudson, E. Rahme, H. Behlouli, R. Sheppard, and L. Pilote Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure Eur J Heart Fail, September 1, 2007; 9(9): 964 - 964. [Full Text] [PDF]

				A. S Hall and M. H Strauss More about the "ARB MI paradox" Heart, September 1, 2007; 93(9): 1011 - 1014. [Abstract] [Full Text] [PDF]