Meta-Analysis of Randomized Trials on the Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Patients ≥65 Years of Age.

Abstract

The comparative efficacy and safety of angiotensin-converting enzyme inhibitors (ACEIs) with other agents in patients ≥65 years of age with cardiovascular diseases or at-risk are unknown. Electronic databases were systematically searched to identify all randomized controlled trials that compared ACEIs with control (placebo or active) and reported long-term cardiovascular outcomes. We required the mean age of patients in the studies to be ≥65 years. Random-effects model was used to pool study results. Sixteen trials with 104,321 patients and a mean follow-up of 2.9 years were included. Compared with placebo, ACEIs significantly reduced all outcomes except stroke. Compared with active controls, ACEIs had similar effect on all-cause mortality (relative risk [RR] 0.99, 95% confidence interval [CI] 0.95 to 1.03), cardiovascular mortality (RR 0.99, 95% CI 0.93 to 1.04), heart failure (RR 0.97, 95% CI 0.91 to 1.03), myocardial infarction (RR 0.94, 95% CI 0.88 to 1.00), and stroke (RR 1.07, 95% CI 0.99 to 1.15). ACEIs were associated with an increased risk of angioedema (RR 2.79, 95% CI 1.05 to 7.42), whereas risk for hypotension and renal insufficiency was similar compared with active controls. Meta-regression analysis showed that the effect of ACEIs on outcomes remained consistent with age increasing ≥65 years. Sensitivity analysis excluding trials comparing ACEIs with angiotensin receptor blockers and heart failure trials yielded similar results, except for reduction in myocardial infarction. In conclusion, the efficacy of ACEIs was similar to active controls for mortality outcomes. Compared with placebo, there was evidence for reduction in cardiovascular outcomes; however, ACEIs failed to prevent stroke and increased the risk of angioedema, hypotension, and renal failure.

• Authors: Chirag Bavishi, Mohammed Ahmed, Vrinda Trivedi, Abdur Rahman Khan, Carlos Gongora, Sripal Bangalore, Franz H Messerli
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 118 Issue 9 Pg. 1427-1436 (Nov 01 2016) ISSN: 1879-1913 [Electronic] United States
• PMID: 27692594 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Age Factors
• Aged
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Cardiovascular Diseases (drug therapy)
• Humans
• Patient Safety
• Randomized Controlled Trials as Topic