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Comparative Study
. 2021 Sep;78(3):591-603.
doi: 10.1161/HYPERTENSIONAHA.120.16667. Epub 2021 Jul 26.

Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study

RuiJun Chen  1   2 , Marc A Suchard  3   4 , Harlan M Krumholz  5   6 , Martijn J Schuemie  3   7 , Steven Shea  8 , Jon Duke  9 , Nicole Pratt  10 , Christian G Reich  11 , David Madigan  12 , Seng Chan You  13 , Patrick B Ryan  1 , George Hripcsak  1   14
Affiliations
Comparative Study

Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study

RuiJun Chen et al. Hypertension. 2021 Sep.

Abstract

[Figure: see text].

Keywords: angiotensin receptor; angiotensin receptor blocker; cardiovascular outcomes; hypertension; safety.

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Figures

Figure 1.
Figure 1.. Covariate balance before and after propensity score stratification across all databases.
Each point represents the standardized difference of means for a single covariate before and after large-scale propensity score stratification in new users of ACE inhibitors and ARBs. All databases achieved covariate balance, defined as a standardized difference of the mean ≤ 0.1, except for the NHIS/NSC database.
Figure 2.
Figure 2.. Preference score distributions across all databases.
Distribution of preference scores, a transformation of propensity score adjusting for differences in prevalence, in new users of ACE inhibitors (red) as compared to ARBs (purple). Greater overlap indicates that patients in the target and comparator populations are more similar in their likelihood of receiving the target treatment. We achieve clinical empirical equipoise in all comparisons except for the NHIS/NSC database.
Figure 3:
Figure 3:. Risk of cardiovascular outcomes in ACE-inhibitors vs ARBs across all databases.
Forest plot of hazard ratios and 95% Cis for primary outcomes of acute myocardial infarction (MI), heart failure, stroke, and composite cardiovascular events (CVE) across all databases and meta-analyses. Meta-analysis 2 excludes the NHIS/NSC database while ‘Meta-analysis’ includes all databases.
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