Abstract
BackgroundAngiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question. The VALUE trial found an increased risk of myocardial infarction in participants receiving ARBs compared to other antihypertensive. The aim of the meta-analysis was to synthetize the available evidence of randomised controlled trials (RCTs) and elucidate if ARBs increase the risk of cardiovascular events.MethodsA comprehensive search was conducted to identify RCTs that assessed the safety of ARBs. Titles and abstracts of all papers were independently screened by two authors. Data extraction and quality assessment were also performed independently. The relative risk (RR) of all-cause mortality, myocardial infarction, and stroke were pooled using the IVhet model. Multiple sensitivity analyses were conducted to assess the effect of ARBs by restricting the analysis to different participants’ characteristics.ResultsForty-five RCTs comprising of 170,794 participants were included in the analysis. The pooled estimates revealed that ARBs do not increase the risk of all-cause mortality (RR 1.00; 95%CI 0.97–1.04), myocardial infarction (RR 1.01; 95%CI 0.96–1.06), and stroke (RR 0.92; 95%CI 0.83–1.01). The sensitivity analysis did not yield a particular group of patients at increased risk of cardiovascular events with ARBs. Risk of all-cause mortality and stroke decreased with ARB when the proportion of smokers in a population was < 25% (RR 0.91; 95%CI 0.84–0.98) and in females (RR 0.76; 95%CI 0.68–0.84), respectively.ConclusionsARBs do not increase the risk of major cardiovascular events and are safe for use in patients.
Highlights
Angiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question
Findings from previous Randomised controlled trial (RCT) were controversial, the VALUE [6] and the CHARM-alternative [7] trials found increase in myocardial infarction with ARBs compared to amlodipine and placebo, respectively
In 2011, Bangalore et al [57] conducted a meta-analysis on ARBs and the risk of myocardial infarction and found that ARBs do not increase the risk of cardiovascular events
Summary
Angiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question. It is well known that the risk of major cardiovascular events can be reduced by a wide spectrum of antihypertensive drugs including angiotensin receptor blockers (ARBs) [3]. This type of drug works by inhibiting the angiotensin II receptors, causing systemic vasodilatation, thereby aiding in the reduction of blood pressure [4]. ARBs are one of the most common drugs used for controlling blood pressure, treating heart failure, and preventing kidney failure in people with diabetes or hypertension [5]. The safety of ARBs in comparison to other anti-hypertensive medications has been called into question
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