Abstract 2392: Effects of Combination Therapy with ACE and ARB in patients with Acute Decompensated Heart Failure or MI: A Meta-analysis
Angiotensin converting enzyme (ACE) therapy reduces mortality and morbidity from cardiovascular causes in patients with vascular diseases or high risk diabetes without heart failure. The role of combination therapy with ACE and angiotensin II receptor blockers (ARB) is not precisely known. We have assessed the effect of combination therapy with ACE and ARB in patients with heart failure or myocardial infarction. Large randomized control trials that included heart failure or myocardial infarction patients in which ACE and ARB were used in combination and compared with ACE therapy alone were included for the meta-analysis. Systematic review of literature was performed in MEDLINE and OVID search engines. Chi-square test was used to assess inter-study heterogeneity. The effect of combination therapy was assessed by calculating Odds ratio using Revmans software. Results were computed using 95% CI and were considered significant with double sided alpha error < 0.05. Four trials (N = 29,732) fulfilled the inclusion criteria for the study. There was a significant benefit towards use of combination therapy using ACE and ARB in reducing the need for hospitalization for heart failure 0.89 [0.83, 0.95] (P = 0.0004). Although combination therapy had no benefit over ACE use for death due to cardiovascular cause and heart failure 0.96 [0.91, 1.01] (P = 0.15). Combination therapy is not inferior for mortality secondary to cardiovascular cause and heart failure. Although the combination therapy is shown to reduce hospitalization secondary to heart failure. There are more side effects with the use of combination therapy and should be used with caution.