Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.

Slides:

Advertisements

Similar presentations

ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial The telmisartan trial in cardiovascular protection Sponsored by Boehringer.

Advertisements

Foos et al, EASD, Lisbon, 13 September 2011 Comparison of ACCORD trial outcomes with outcomes estimated from modelled and meta- analysis studies Volker.

CONSENSUS: Cooperative North Scandinavian Enalapril Survival Study Purpose To determine whether the ACE inhibitor enalapril reduces mortality in patients.

MIRACL, Val-HeFT, Cheney Clinical Trial Commentary Dr Eric Topol Chairman and Professor, Department of Cardiology Director of the Joseph J Jacobs Center.

TNT: Study Design Treating to New Targets 2 5 years 10,001 Patients Clinically evident CHD LDL-C 130  250 mg/dL following up to 8-week washout and 8-week.

חזק בהגנה לבבית Valsartan in Heart Failure

Rimoldi SF et al. J Clin Hypertens (Greenwich). 2015;17(3): Efficacy and safety of calcium channel blocker/diuretics combination therapy in hypertensive.

The ONTARGET Trial Reference The ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:15.

analysis from the SHIFT study

TOTAL Stroke in the TOTAL trial: Randomized trial of manual aspiration Thrombectomy in STEMI TOTAL Trial Investigators.

VBWG IDEAL: The Incremental Decrease in End Points Through Aggressive Lipid Lowering Study.

TRANSCEND: Telmisartan Randomized AssesmeNt Study in aCE iNtolerant Subjects with Cardiovascular Disease ONTARGET / TRANSCEND Investigators Koon K. Teo,

COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Purpose To compare the efficacy of optimal medical therapy (OMT)

Appendix: Clinical Guidelines VBWG. I Intervention is useful and effective III Intervention is not useful or effective and may be harmful A Data derived.

CHARM-Alternative: Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Alternative Purpose To determine whether the angiotensin.

CHARM-Preserved: Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Preserved Purpose To determine whether the angiotensin.

Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose? Systolic.

The Long Term Multi-Center Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) study To reviewers and moderators: These.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT study overview Double-blind, randomized trial to determine whether.

Pravastatin in Elderly Individuals at Risk of Vascular Disease Presented at Late Breaking Clinical Trials AHA 2002 PROSPER.

ACUTE STROKE — Hypertension is a common problem in patients with both type 1 and type 2 diabetes but the time course in relation to the duration.

VBWG CHARISMA Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance trial.

Clinical Outcomes with Newer Antihyperglycemic Agents

VBWG OASIS-5 The Fifth Organization to Assess Strategies in Acute Ischemic Syndromes trial.

ACTIVE Clopidogrel plus Aspirin versus Aspirin in Patients Unsuitable for Warfarin.

1 Role of Candesartan. Antagonist: AT 1 receptor interaction Losartan Candesartan Rapid dissociation Slow dissociation Lower affinity High affinity Re-association.

S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial Main results Swedberg K, et al. Lancet. 2010;376(9744):

Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Development of Glucose Intolerance and New-onset Diabetes Mellitus.

Prasugrel vs. Clopidogrel for Acute Coronary Syndromes Patients Managed without Revascularization — the TRILOGY ACS trial On behalf of the TRILOGY ACS.

Avoiding Cardiovascular Events through COMbination Therapy in Patients LIving with Systolic Hypertension The First Outcomes Trial of Initial Therapy With.

Aim To determine the effects of a Coversyl- based blood pressure lowering regimen on the risk of recurrent stroke among patients with a history of stroke.

AIRE: Acute Infarction Ramipril Efficacy study Purpose To determine whether the ACE inhibitor ramipril reduces mortality in patients with evidence of heart.

TRANSCEND: Telmisartan Randomized AssesmeNt Study in aCE iNtolerant Subjects with Cardiovascular Disease ONTARGET / TRANSCEND Investigators Koon K. Teo,

HOPE: Heart Outcomes Prevention Evaluation study Purpose To evaluate whether the long-acting ACE inhibitor ramipril and/or vitamin E reduce the incidence.

Evidence-Based Medicine ACE-Inhibitor and ARB; combination therapy

Review of an article Not all Angiotension-Converting Enzyme (ACE) inhibitors are Equal: Focus on Ramipril and Perindopril DiNicolantonio J, Lavie C, O’Keefe.

Enrollment, Randomization, and Follow-up of Study Participants ADVANCE Collaborative Group. N Engl J Med 2008;358:

Beckett N, Peters R, Tuomilehto J, et al. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment.

Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.

COMET: Carvedilol Or Metoprolol European Trial Purpose To compare the effects of carvedilol (a β 1 -, β 2 - and α 1 -receptor blocker) and short-acting.

Clinical Outcomes with Newer Antihyperglycemic Agents FDA-Mandated CV Safety Trials 1.

Relationship of background ACEI dose to benefits of candesartan in the CHARM-Added trial.

OVERTURE FDA Cardiovascular and Renal Drugs Advisory Committee Meeting July 19, 2002 Milton Packer, M.D., FACC Columbia University College of Physicians.

1 ALLHAT Antihypertensive Trial Results by Baseline Diabetic Status January 28, 2004.

VBWG OASIS-6 The Sixth Organization to Assess Strategies in Acute Ischemic Syndromes trial.

Rosuvastatin 10 mg n=2514 Placebo n= to 4 weeks Randomization 6weeks3 monthly Closing date 20 May 2007 Eligibility Optimal HF treatment instituted.

COPERNICUS: Carvedilol Prospective Randomized Cumulative Survival trial Purpose To assess the effect of carvedilol, a β 1 -, β 2 - and α 1 -receptor blocker,

Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.

Date of download: 6/23/2016 From: Screening for, Monitoring, and Treatment of Chronic Kidney Disease Stages 1 to 3: A Systematic Review for the U.S. Preventive.

Date of download: 6/27/2016 Copyright © The American College of Cardiology. All rights reserved. From: Use and Outcomes of Triple Therapy Among Older Patients.

Date of download: 7/5/2016 Copyright © The American College of Cardiology. All rights reserved. From: Early Aldosterone Blockade in Acute Myocardial Infarction:

The FAVORIT Study (Folic Acid for Vascular Outcome Reduction in Transplantation) Source Bostom AG, Carpenter MA, Kusek JW, et al. Homocysteine-lowering.

Date of download: 7/9/2016 Copyright © The American College of Cardiology. All rights reserved. From: Making Sense of Statistics in Clinical Trial Reports:

Antonio Coca, MD, PhD, FRCP, FESC

Reducing Adverse Outcomes after ACS in Patients with Diabetes Goals

Flow of Individuals Through the Vitamin E and Vitamin C Components of the Physicians’ Health Study II Howard D. Sesso et al. JAMA 2008;300:

Blood Pressure and Age in Controlling Hypertension

Copyright © 2005 American Medical Association. All rights reserved.

LEADER trial: Primary Outcome

First time a CETP inhibitor shows reduction of serious CV events

Valsartan in Acute Myocardial Infarction Trial Investigators

RAAS Blockade: Focus on ACEI

Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH): Design Randomized, double-blind.

ATMOSPHERE Trial design: Patients with symptomatic heart failure were randomized in a 1:1:1 fashion to either aliskiren 300 mg once daily, enalapril 5.

NIPPON Trial design: Patients undergoing percutaneous coronary intervention were randomized to short-term dual antiplatelet therapy (DAPT) (6 months; n.

Mancini JG, et al. Am J Cardiol.

Assessing the Burden of Hyperkalemia

EMPA-REG OUTCOME: Cumulative incidence of the primary outcome

MRRs and EMRRs for women with ACS

Christian Madelaire et al. JCHF 2018;6:

Presentation transcript:

Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.

Background Current guidelines in hypertension and heart failure recommend ARBs in patients who are intolerant to ACE inhibitors. The average age of hypertensive patients is 65 years old and above.

Main objective of the study To assess the effect of ARBs on a wide range of outcomes to get a complete understanding of the benefits and harms of ARBs.

Methodology 16 trials with ARBs as active treatment patients The mean age of the population in each trial had to be more than 65 years Mean follow-up: 39 months

Main results of the study Random effects model for the efficacy and safety outcomes in the ARB group vs the control (agent or placebo) group Outcome ARB Incidence (%) Control Incidence (%) RR95% CIP value All-cause mortality MI Stroke Heart failure hospitalization Acute kidney injury <0.001 Hypotension <0.001 Hyperkalemia Abbreviations: ARB, angiotensin receptor blocker; CI, confidence interval; MI, myocardial infarction; RR, risk ratio.

Conclusion ARBs were associated with a marginal increase in all-cause mortality when compared with an active agent. The low hazard ratio was directionally in line with the cumulative effects of hypotension, acute kidney injury, and hyperkalemia. Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.