Abstract 3465: Meta-analyses Of Mortality And Morbidity Effects Of Angiotensin Receptor Blockers In Patients With Chronic Heart Failure.
Background: Although individual clinical trials may be large enough to show effects of Angiotensin receptor blockers (ARBs) on the aggregate of all CHF events, they might well over estimate or under estimate any effects on CHF death or hospitalizations. Hence we undertook the meta-analyses from all relevant randomized trials of ARBS that were used as an add-on or as an alternative to ACE inhibitors(ACEI) in patients receiving standard CHF therapy.
Methods: We searched presently available mortality and composite data (death, hospitalization) from randomized, controlled clinical trials of ARBS in CHF patients with NYHA class II/III either as Add-on to standard therapy or as an alternative to ACEI.
Results: A total of 6 randomized trials with ARBs were found. The overall pooled data showed no significant mortality benefit with the use of ARBs ( RR 0.970, 0.91–1.04, P=0.3657). However, the overall composite data on mortality or hospitalization was significantly better for ARBs ( RR 0.94, 0.90 – 0.98, P=0.0055). In patients receiving ARBs as an add-on there was no significant mortality benefit but the composite data were significantly better (RR 0.91, 0.85– 0.97, p=0.0026). As an alternative to ACEI, the pooled data comparing ACEI and ARBs showed no difference for either mortality or composite end points, in contrast to Charm-alternative which showed better outcome for ARBs vs Placebo.
Conclusions: The pooled data on the effect of ARBs in NYHA class II/III did not show mortality benefit either as an add-on or as an alternative to ACEI in patients receiving standard therapy. However ARBS effect on the composite of death or hospitalization is significant especially when ARBs are used as an Add-on.