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Meta-Analysis
. 2012 Apr 18;2012(4):CD003040.
doi: 10.1002/14651858.CD003040.pub2.

Angiotensin receptor blockers for heart failure

Balraj S Heran  1 , Vijaya M Musini, Ken Bassett, Rod S Taylor, James M Wright
Affiliations
Meta-Analysis

Angiotensin receptor blockers for heart failure

Balraj S Heran et al. Cochrane Database Syst Rev. .

Abstract

Background: Chronic heart failure (HF) is a prevalent world-wide. Angiotensin receptor blockers (ARBs) are widely prescribed for chronic HF although their role is controversial.

Objectives: To assess the benefit and harm of ARBs compared with ACE inhibitors (ACEIs) or placebo on mortality, morbidity and withdrawals due to adverse effects in patients with symptomatic HF and left ventricular systolic dysfunction or preserved systolic function.

Search methods: Clinical trials were identified by searching CENTRAL, HTA, and DARE , (The Cochrane Library 2010 Issue 3), as well as MEDLINE (2002 to July 2010), and EMBASE (2002 to July 2010). Reference lists of retrieved articles and systematic reviews were checked for additional studies not identified by the electronic searches.

Selection criteria: Double blind randomised controlled trials in men and women of all ages who have symptomatic (NYHA Class II to IV) HF and: 1) left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) ≤40%; or 2) preserved ejection fraction, defined as LVEF >40%.

Data collection and analysis: Two authors independently assessed risk of bias and extracted data from included studies.

Main results: Twenty two studies evaluated the effects of ARBs in 17,900 patients with a LVEF ≤40% (mean 2.2 years). ARBs did not reduce total mortality (RR 0.87 [95% CI 0.76, 1.00]) or total morbidity as measured by total hospitalisations (RR 0.94 [95% CI 0.88, 1.01]) compared with placebo.Total mortality (RR 1.05 [95% CI 0.91, 1.22]), total hospitalisations (RR 1.00 [95% CI 0.92, 1.08]), MI (RR 1.00 [95% CI 0.62, 1.63]), and stroke (RR 1.63 [0.77, 3.44]) did not differ between ARBs and ACEIs but withdrawals due to adverse effects were lower with ARBs (RR 0.63 [95% CI 0.52, 0.76]). Combinations of ARBs plus ACEIs increased the risk of withdrawals due to adverse effects (RR 1.34 [95% CI 1.19, 1.51]) but did not reduce total mortality or total hospital admissions versus ACEI alone.Two placebo-controlled studies evaluated ARBs in 7151 patients with a LVEF >40% (mean 3.7 years). ARBs did not reduce total mortality (RR 1.02 [95% CI 0.93, 1.12]) or total morbidity as measured by total hospitalisations (RR 1.00 [95% CI 0.97, 1.05]) compared with placebo. Withdrawals due to adverse effects were higher with ARBs versus placebo when all patients were pooled irrespective of LVEF (RR 1.06 [95% CI 1.01, 1.12]).

Authors' conclusions: In patients with symptomatic HF and systolic dysfunction or with preserved ejection fraction, ARBs compared to placebo or ACEIs do not reduce total mortality or morbidity. ARBs are better tolerated than ACEIs but do not appear to be as safe and well tolerated as placebo in terms of withdrawals due to adverse effects. Adding an ARB in combination with an ACEI does not reduce total mortality or total hospital admission but increases withdrawals due to adverse effects compared with ACEI alone.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

1
1
PRISMA flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of ARBs versus placebo for total mortality in HF patients with EF ≤40%
5
5
Forest plot of ACE inhibitor enalapril versus placebo for total hospitalisations.
6
6
Forest plot of ACE inhibitor enalapril versus placebo for hospitalisations for heart failure.
7
7
Forest plot of ACE inhibitor enalapril versus placebo for other hospitalisations.
1.1
1.1. Analysis
Comparison 1: ARBs versus placebo, Outcome 1: Total mortality
1.2
1.2. Analysis
Comparison 1: ARBs versus placebo, Outcome 2: Cardiovascular mortality
1.3
1.3. Analysis
Comparison 1: ARBs versus placebo, Outcome 3: Non‐cardiovascular mortality
1.4
1.4. Analysis
Comparison 1: ARBs versus placebo, Outcome 4: MI
1.5
1.5. Analysis
Comparison 1: ARBs versus placebo, Outcome 5: Stroke
1.6
1.6. Analysis
Comparison 1: ARBs versus placebo, Outcome 6: Total hospitalisations
1.7
1.7. Analysis
Comparison 1: ARBs versus placebo, Outcome 7: Hospitalisations for heart failure
1.8
1.8. Analysis
Comparison 1: ARBs versus placebo, Outcome 8: Other hospitalisations
1.9
1.9. Analysis
Comparison 1: ARBs versus placebo, Outcome 9: WDAE
2.1
2.1. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 1: Total mortality
2.2
2.2. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 2: Cardiovascular mortality
2.3
2.3. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 3: Non‐cardiovascular mortality
2.4
2.4. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 4: MI
2.5
2.5. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 5: Stroke
2.6
2.6. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 6: Total hospitalisations
2.7
2.7. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 7: Hospitalisations for heart failure
2.8
2.8. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 8: Other hospitalisations
2.9
2.9. Analysis
Comparison 2: ARBs versus ACE inhibitors, Outcome 9: WDAE
3.1
3.1. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 1: Total mortality
3.2
3.2. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 2: Cardiovascular mortality
3.3
3.3. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 3: Non‐cardiovascular mortality
3.4
3.4. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 4: MI
3.5
3.5. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 5: Stroke
3.6
3.6. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 6: Total hospitalisations
3.7
3.7. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 7: Hospitalisations for heart failure
3.8
3.8. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 8: Other hospitalisations
3.9
3.9. Analysis
Comparison 3: ARB plus ACEI versus ACEI alone, Outcome 9: WDAE
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003040

References

References to studies included in this review

ADEPT 2001 {published data only}
    1. Murdoch DR, McDonagh TA, Farmer R, Morton JJ, McMurray JJV, Dargie HJ. ADEPT: Addition of the AT1 receptor antagonist eprosartan to ACEI inhibitor therapy in chronic heart failure trial: Hemodynamic and neurohormonal effects. American Heart Journal 2001;141(5):800-7. - PubMed
ARCH‐J 2003 {published data only}
    1. Matsumori A. Efficacy and safety of oral candesartan cilexitil in patients with congestive heart failure. European Journal of Heart Failure 2003;5:669-77. - PubMed
CHARM‐Added 2003 {published data only}
    1. McMurray JJV, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003;362:762-71. - PubMed
    1. Weir RAP, McMurray JJV, Puu M, Solomon SD, Olofsson B, Granger CB, Yusuf S, Michelson EL, Swedberg K, Pfeffer MA. Efficacy and tolerability of adding an angiotensin receptor blocker in patients with heart failure already receiving an angiotensin-converting inhibitor plus aldosterone antagonist, with or without a beta blocker. Findings from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial. European Journal of Heart Failure 2008;10:157-63. - PubMed
CHARM‐Alternative 2003 {published data only}
    1. Granger CB, McMurray JJV, Yusuf S, Held P, Michelson EL, Olofsson B, Ostergren J, Pfeffer MA, Swedberg K. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet 2003;362:772-6. - PubMed
CHARM‐Preserved 2003 {published data only}
    1. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJV, Michelson EL, Olofsson B, Östergren J. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003;362:777-81. - PubMed
Crozier 1995 {published data only}
    1. Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L, Rucinska E. Losartan in heart failure. Hemodynamic effects and tolerability. Circulation 1995;91(3):691-7. - PubMed
    1. Klinge R, Polis A, Dickstein K, Hall C. Effects of angiotensin II receptor blockade on N-terminal proatrial natriuretic factor plasma levels in chronic heart failure. Journal of Cardiac Failure 1997;3(2):75-81. - PubMed
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
    1. Weber M. Clinical safety and tolerability of losartan. Clinical Therapeutics 1997;19(4):604-16. - PubMed
Dickstein 1995 {published data only}
    1. Dickstein K, Chang P, Willenheimer R, Haunso S, Remes J, Hall C, Kjekshus J. Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe chronic heart failure. Journal of the American College of Cardiology 1995;26(2):438-45. - PubMed
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
ELITE 1997 {published data only}
    1. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan In the Elderly Study, ELITE). Lancet 1997;349:747-52. - PubMed
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
ELITE II 2000 {published data only}
    1. Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial - the Losartan Heart Failure Survival Study ELITE II. Lancet 2000;355:1582-7. - PubMed
Hamroff 1999 {published data only}
    1. Hamroff G, Katz SD, Mancini D, Blaufarb I, Bijou R, Patel R, Jondeau G, Olivari MT, Thomas S, Le Jemtel TH. Addition of angiotensin II receptor blockade to maximal angiotensin-converting enzyme inhibition improves exercise capacity in patients with severe congestive heart failure. Circulation 1999;99:990-2. - PubMed
HEAVEN 2002 {published data only}
    1. Willenheimer R, Helmers C, Pantev E, Rydberg E, Lofdahl P, Gordon A. Safety and efficacy of valsartan versus enalapril in heart failure patients. International Journal of Cardiology 2002;85:261-70. - PubMed
I‐PRESERVE 2008 {published data only}
    1. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A. Irbesartan in patients with heart failure and preserved ejection fraction. New England Journal of Medicine 2008;359(23):2456-67. - PubMed
    1. Zile MR, Gaasch WH, Anand IS, Haass M, Little WC, Miller AB, Lopez-Sendon J, Teerlink JR, White M, McMurray JJ, Komajda M, McKelvie R, Ptaszynska A, Hetzel SJ, Massie BM, Carson PE. Mode of death in patients with heart failure and a preserved ejection fraction: results from the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-Preserve) trial. Circulation 2010;121:1393-405. - PubMed
Lang 1997 {published data only}
    1. Lang RM, Elkayam U, Yellen LG, Krauss D, McKelvie RS, Vaughan DE, Ney DE, Makris L, Chang PI. Comparative effects of losartan and enalapril on exercise capacity and clinical status in patients with heart failure. Journal of the American College of Cardiology 1997;30(4):983-91. - PubMed
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
Mazayev 1998 {published data only}
    1. Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO. Valsartan in heart failure patients previously untreated with an ACE inhibitor. International Journal of Cardiology 1998;65:239-46. - PubMed
Mitrovic 2003 {published data only}
    1. Mitrovic V, Willenbrock R, Miric M, Seferovic P, Spinar J, Dabrowski M, Kiowski W, Marks DS, Alegria E, Dukat A, Lenz K, Arens HA. Acute and 3-month treatment effects of candesartan cilexitil on hemodynamics, neurohormones, and clinical symptoms in patients with congestive heart failure. American Heart Journal 2003;145(3):D1-D9. - PubMed
REPLACE 2001 {published data only}
    1. Dunselman PHJM. Effects of the replacement of the angiotensin converting enzyme inhibitor enalapril by the angiotensin II receptor blocker telmisartan in patients with congestive heart failure. The replacement of angiotensin converting enzyme inhibition (REPLACE) investigators. International Journal of Cardiology 2001;77:131-8. - PubMed
RESOLVD 1999 {published data only}
    1. McKelvie RS, Yusuf S, Pericak D, Avezum A, Burns RJ, Probstfield J, Tsuyuki RT, White M, Rouleau J, Latini R, Maggioni A, Young J, Pogue J. Comparison of candesartan, enalapril, and their combination in congestive heart failure. Randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. Circulation 1999;100:1056-64. - PubMed
Sharma 2000, III‐Int'l {published data only}
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
Sharma 2000, III‐US {published data only}
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. American Journal of Cardiology 2000;85:187-92. - PubMed
SPICE 2000 {published data only}
    1. Granger CB, Ertl G, Kuch J, Maggioni AP, McMurray J, Rouleau JL, Stevenson LW, Swedberg K, Young J, Yusuf S, Califf RM, Bart BA, Held P, Michelson EL, Sellers MA, Ohlin G, Sparapani R, Pfeffer MA. Randomized trial of candesartan cilexitil in the treatment of patients with congestive heart failure and a history of intolerance to angiotensin-converting enzyme inhibitors. American Heart Journal 2000;139:609-17. - PubMed
STRETCH 1999 {published data only}
    1. Riegger GAJ, Bouzo H, Petr P, Munz J, Spacek R, Pethig H, Behren V, George M, Arens HJ. Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexitil. Circulation 1999;100:2224-30. - PubMed
Tonkon 2000 {published data only}
    1. Tonkon M, Awan N, Niazi I, Hanley P, Baruch L, Wolf RA, Block AJ. A study of the efficacy and safety of irbesartan in combination with conventional therapy, including ACE inhibitors, in heart failure. International Journal of Clinical Practice 2000;54:11-8. - PubMed
Val‐HeFT 2001 {published data only}
    1. Cohn JN, Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. New England Journal of Medicine 2001;345:1667-75. - PubMed
V‐HeFT 1999 {published data only}
    1. Baruch L, Anand I, Cohen IS, Ziesche S, Judd D, Cohn JN. Augmented short- and long-term hemodynamic and hormonal effects of an angiotensin receptor blocker added to angiotensin converting enzyme inhibitor therapy in patients with heart failure. Circulation 1999;99:2658-64. - PubMed

References to studies excluded from this review

Belousov 2005 {published data only}
    1. Belousov IB, Upnitskii AA, Khanina NI. [Effect of long-term therapy with contemporary drugs on diastolic cardiac function in patients with chronic heart failure]. Kardiologiia 2005;45:26-32. - PubMed
Berezin 2001 {published data only}
    1. Berezin AE. Angiotensin-II receptor antagonist losartan dose-dependently improves the left ventricular remodelling in patients with congestive heart failure. Journal of Clinical & Basic Cardiology 2002;5(Issue 1):83-6.
    1. Berezin AE. Losartan in the therapy of heart failure patients. Asian Cardiovascular & Thoracic Annals 2001;9:302-7.
Blanchet 2005 {published data only}
    1. Blanchet M, Sheppard R, Racine N, Ducharme A, Curnier D, Tardif JC, Sirois P, Lamoureux MC, De Champlain J, White M. Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure. American Heart Journal 2005;149:938.e1-7. - PubMed
De Tommasi 2003 {published data only}
    1. De Tommasi E, Iacoviello M, Romito R, Ceconi C, Guida P, Massari F, Francolini G, Bertocchi F, Ferrari R, Rizzon P, Pitzalis MV. Comparison of the effect of valsartan and lisinopril on autonomic nervous system activity in chronic heart failure. American Heart Journal 2003;146:E17. - PubMed
Ellis 2002 {published data only}
    1. Ellis GR, Nightingale AK, Blackman DJ, Anderson RA, Mumford C, Timmins G, Lange D, Jackson SK, Penney MD, Lewis MJ, Frenneaux MP, Morris-Thurgood J. Addition of candesartan to angiotensin converting enzyme inhibitor therapy in patients with chronic heart failure does not reduce levels of oxidative stress. European Journal of Heart Failure 2002;4:193-9. - PubMed
Guazzi 1999 {published data only}
    1. Guazzi M, Palermo P, Pontone G, Susini F, Agostoni P. Synergistic efficacy of enalapril and losartan on exercise performance and oxygen consumption at peak exercise in congestive heart failure. American Journal of Cardiology 1999;84:1038-43. - PubMed
HEAAL 2009 {published data only}
    1. Konstam MA, Neaton JD, Dickstein K, Drexler H, Komajda M, Martinez FA, Riegger GAJ, Malbecq W, Smith RD, Guptha S, Poole-Wilson PA. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet 2009;374(9704):1840-8. - PubMed
    1. Konstam MA, Poole-Wilson PA, Dickstein K, Drexler H, Justice SJ, Komajda M, Malbecq W, Martinez FA, Neaton JD, Riegger GAJ, Guptha S. Design of the heart failure endpoint evaluation of AII-antagonist losartan (HEAAL) study in patients intolerant to ACE-inhibitor. European Journal of Heart Failure 2008;10:899-906. - PubMed
Hikosaka 2002 {published data only}
    1. Hikosaka M, Yuasa F, Yuyama R, Mimura J, Kawamura A, Motohiro M, Iwasaki M, Sugiura T, Iwasaka T. Candesartan and arterial baroreflex sensitivity and sympathetic nerve activity in patients with mild heart failure. Journal of Cardiovascular Pharmacology 2002;40:875-80. - PubMed
Houghton 2000 {published data only}
    1. Houghton AR, Harrison M, Cowley AJ, Hampton JR. Combined treatment with losartan and an ACE inhibitor in mild to moderate heart failure: results of a double-blind, randomized, placebo-controlled trial. American Heart Journal 2000;140:e25. - PubMed
Kasama 2003 {published data only}
    1. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, Kurabayashi M. Addition of valsartan to an angiotensin-converting enzyme inhibitor improves cardiac sympathetic nerve activity and left ventricular function in patients with congestive heart failure. Journal of Nuclear Medicine 2003;44:884-90. - PubMed
Kasama 2005 {published data only}
    1. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, Kurabayashi M. Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction. Journal of the American College of Cardiology 2005;45(5):661-7. - PubMed
Ki 2008 {published data only}
    1. Ki HL, Myung HJ, Young KA, Woo SL, Dae HJ, Jeong GC, Jong CP, Jung CK, Seok KO, Nam HK, Kyung HY, Nam JY, Moon Y, Jay YR, Ji HL, Seong HJ, Ok YP, Seung UL, Dong GK. [The comparative clinical effects of valsartan and ramipril in patients with heart failure]. Korean Circulation Journal 2008;38:101-9.
Nakamura 2002 {published data only}
    1. Nakamura M, Saito S, Yoshida H, Arakawa N, Sugawara S, Hiramori K. Effects of chronic subdepressor dose of angiotensin II type 1 receptor antagonist on endothelium-dependent vasodilation in patients with congestive heart failure. Journal of Cardiovascular Pharmacology 2002;40(3):411-9. - PubMed
Parthasarathy 2009 {published data only}
    1. Parthasarathy HK, Pieske B, Weisskopf M, Andrews CD, Brunel P, Struthers AD, MacDonald TM. A randomized, double-blind, placebo-controlled study to determine the effects of valsartan on exercise time in patients with symptomatic heart failure with preserved ejection fraction. European Journal of Heart Failure 2009;11:980-9. - PMC - PubMed
SADKO‐CHF 2005 {published data only}
    1. Skvortsov AA, Nasonova SN, Sychev AV, Arbolishvili GN, Baklanova NA, Mareev V, Belenkov N. [Combined therapy with quinapril, an ACE inhibitor, and valsartan, a type 1 angiotensin II receptors blocker, for moderate chronic cardiac failure may raise the degree of neurohormonal block and improve 24-h heart rate variability compared to the effect of monotherapy (data from the trial SADKO-CHF)]. Terapevticheski Arkhiv 2005;77(8):34-43. - PubMed
    1. Skvortsov AA, Nasonova SN, Sychev AV, Orlova A, Baklanova NA, Masenko VP, Mareev V, Belenkov N. [Effects of long term therapy with angiotensin converting enzyme inhibitor quinapril, antagonist of receptors to angiotensin II valsartan, and combination of quinapril and valsartan in patients with moderate chronic heart failure. Main results of the SADKO-CHF study]. Kardiologiia 2006;46:33-51. - PubMed
Tang 2003 {published data only}
    1. Tang B, Sun H, Ma Y. Effect of losartan and captopril on congestive heart failure. Journal of Xingjiang Medical University 2003;26(5):424-6.
Tsutamoto 2000 {published data only}
    1. Tsutamoto T, Wada A, Maeda K, Mabuchi N, Hayashi M, Tsutsui T, Ohnishi M, Sawaki M, Fujii M, Matsumoto T, Kinoshita M. Angiotensin II type 1 receptor antagonist decreases plasma levels of tumor necrosis factor alpha, interleukin-6 and soluble adhesion molecules in patients with chronic heart failure. Journal of the American College of Cardiology 2000;35(3):714-21. - PubMed
Vaile 2001 {published data only}
    1. Vaile JC, Chowdhary S, Osman F, Ross HF, Fletcher J, Littler WA, Coote JA, Townend JN. Effects of angiotensin II (AT1) receptor blockade on cardiac vagal control in heart failure. Clinical Science 2001;101:559-66. - PubMed
Vizir 2000 {published data only}
    1. Vizir VA, Berezin AE. [Losartan in therapy of chronic heart failure]. Klinicheskaia Meditsina 2000;78(2):36-9. - PubMed
Vizir 2002 {published data only}
    1. Vizir VA, Berezin AE. [Effect of long-term treatment with enalapril, losartan and their combination on the quality of life of patients with congestive heart failure]. Terapevticheski Arkhiv 2002;74(1):52-5. - PubMed
Ye 2005 {published data only}
    1. Ye JF, Liu DS. Effects of benazepril combined with valsartan on congestive heart failure. Journal of First Military Medical University 2005;25(11):1441-2, 1447. - PubMed

Additional references

ACCF/AHA 2009
    1. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW. Focused Update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119:1977-2016. - PubMed
AIRE 1993
    1. Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342:821-8. - PubMed
Azizi 2004
    1. Azizi M, Menard J. Combined blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors and angiotensin II type 1 antagonists. Circulation 2004;109:2492-9. - PubMed
CCS 2006
    1. Arnold JM, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, Heckman GA, Howlett JG, Ignaszewski A, Johnstone DE, Jong P, McKelvie RS, Moe GW, Parker JD, Rao V, Ross HJ, Sequeira EJ, Svendsen AM, Teo K, Tsuyuki RT, White M, Canadian Cardiovascular Society. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management. Canadian Journal of Cardiology 2006;22(1):23-45. - PMC - PubMed
Egger 1997
    1. Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 9-13-1997;315(7109):629-634. [MEDLINE: ] - PMC - PubMed
Erhardt 2005
    1. Erhardt LR. A review of the current evidence for the use of angiotensin receptor blockers in chronic heart failure. International Journal of Clinical Practice 2005;59(5):571-8. - PubMed
ESC 2008
    1. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, Stromberg A, Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Heart Journal 2008;29:2388-2442. - PubMed
Flather 2000
    1. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G, Torp-Pedersen C, Ball S, Pogue J, Moye L, Braunwald E. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. Lancet 2000;355(9215):1575-81. - PubMed
Heran 2008a
    1. Heran BS, Wong MM, Heran IK, Wright JM. Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD003823. [DOI: 10.1002/14651858.CD003823.pub2] - DOI - PMC - PubMed
Heran 2008b
    1. Heran BS, Wong MMY, Heran IK, Wright JM. Blood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No: CD003822. [DOI: 10.1002/14651858.CD003822.pub2] - DOI - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0.. In: The Cochrane Collaboration. Available from www.cochrane-handbook.org: Wiley-Blackwell, 2011.
Jong 2002b
    1. Jong P, Demers C, McKelvie RS, Liu P. Angiotensin receptor blockers for heart failure. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No: CD003040. [DOI: 10.1002/14651858.CD003040] - DOI - PMC - PubMed
Lakhdar 2008
    1. Lakhdar R, Al-Mallah MH, Lanfear DE. Safety and tolerability of angiotensin-converting enzyme inhibitor versus the combination of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker in patients with left ventricular dysfunction: a systematic review and meta-analysis of randomized controlled trials. Journal of Cardiac Failure 2008;14(3):181-8. - PubMed
Lee 2004
    1. Lee VC, Rhew DC, Dylan M, Badamgarav E, Braunstein GD, Weingarten SR. Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high-risk acute myocardial infarction. Annals of Internal Medicine 2004;141:693-704. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Galnville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S, editor(s) Cochrane Handbook for Systematic Reviews of Interventions Vetsion 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.
Mancia 2009
    1. Mancia G, Corrao G. Targeting blood pressure in the management of total cardiovascular risk. European Heart Journal Supplements 2009;11(Supplement F):F27-32.
McMurray 2005
    1. McMurray JJV, Pfeffer MA. Heart failure. Lancet 2005;365:1877-89. - PubMed
SAVE 1992
    1. Pfeffer MA, Braunwald E, Moyé LA, Basta L, Brown Jr EJ, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC, Klein M, Lamas GA, Packer M, Rouleau J, Rouleau JL, Rutherford J, Wertheimer JH, Hawkins CM. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. New England Journal of Medicine 1992;327(10):669-77. - PubMed
Shah 2010
    1. Shah RV, Desai AS, Givertz MM. The effect of renin-angiotensin system inhibitors on mortality and heart failure hospitalization in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis. Journal of Cardiac Failure 2010;16(3):260-7. - PubMed
Sharma 2000
    1. Sharma D, Buyse M, Pitt B, Rucinska EJ. Meta-analysis of observed mortality data from all-controlled, double-blind, multiple-dose studies of losartan in heart failure. Am J Cardiol 2000;85(2):187-192. [MEDLINE: ] - PubMed
Shibata 2008
    1. Shibata M C, Tsuyuki R T, Wiebe N. The effects of angiotensin-receptor blockers on mortality and morbidity in heart failure: a systematic review. International Journal of Clinical Practice 2008;62(9):1397-402. - PubMed
Smith 2008
    1. Smith DHG. Comparison of angiotensin II type 1 receptor antagonists in the treatment of essential hypertension. Drugs 2008;68(9):1207-25. - PubMed
SOLVD prevention 1992
    1. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. New England Journal of Medicine 1992;327:685-91. - PubMed
SOLVD treatment 1991
    1. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New England Journal of Medicine 1991;325:293-302. - PubMed
TRACE 1995
    1. Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole DS, Auglert L, Pauly NC, Aliot E, Persson S, Camm AJ. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine 1995;333(25):1670-6. - PubMed
Volpe 2009
    1. Volpe M, Toccia G, Sciarretta S, Verdecchia P, Trimarco B, Mancia G. Angiotensin II receptor blockers and myocardial infarction: an updated analysis of randomized clinical trials. Journal of Hypertension 2009;27(5):941-6. - PubMed
Weber 1997
    1. Weber M. Clinical safety and tolerability of losartan. Clinical Therapeutics 1997;19(4):604-16. - PubMed
White 2011
    1. White WB, Weber MA, Sica D, Bakris GL, Perez A, Cao C, Kupfer S. Effects of the angiotensin receptor blocker azilsartan medoxomil versus olmesartan and valsartan on ambulatory and clinic blood pressure in patients with stages 1 and 2 hypertension. Hypertension 2011;57:413-20. - PubMed
Wolny 1997
    1. Wolny A, Clozel J, Rein J, Mory P, Vogt P, Turino M, et al. Functional and biochemical analysis of angiotensin II forming pathways in the human heart. Circulation Research 1997;80:219-27. - PubMed

References to other published versions of this review

Jong 2002
    1. Jong P, Demers C, McKelvie RS, Liu PP. Angiotensin receptor blockers in heart failure: Meta-analysis of randomized controlled trials. Journal of the American College of Cardiology 2002;39(3):463-70. - PubMed

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