Table 5.
Effect of combination ACEI/ARB on cardiovascular events
| Trial (reference) | N | Population | Treatment | All-cause mortality | Cardiovascular mortality | CHF admission | Composite |
|---|---|---|---|---|---|---|---|
| Cohn et al (30) | 2548 | CHF with low EF | Valsartan 160 mg bid vs. placebo added onto current ACEIa | HR 1.02 (95% CI, 0.88 to 1.18) | Not stated | Decrease by 27.5% (13.8% vs. 18.2%), P < 0.001 | Death, CHF, cardiac arrest with resuscitation, iv inotrope/vasodilator HR 0.87 (95% CI, 0.77 to 0.97) |
| CHARM Added (19) | 5010 | CHF with low EF | Candesartan 32 mg vs. placebo added onto current ACEIb | HR 0.89 (95% CI, 0.77 to 1.02) | 0.84 (95% CI, 0.72 to 0.98) | HR 0.83 (95% CI, 0.71 to 0.96), P = 0.014 | Cardiovascular death, MI, CHF, stroke HR 0.87 (95% CI, 0.77 to 0.98) |
| VALIANT (31) | 14,703 (3-arm study) | Acute MI with clinical heart failure or low EF | Valsartan 160 mg bid vs. captopril 50 mg tid vs. valsartan 80 mg bid plus captopril 50 mg tid | HR 0.98 (97.5% CI, 0.89 to 1.09) for combination vs. captopril | HR 1.00 (97.5% CI, 0.89 to 1.11) combination therapy vs. captopril | 17.1% vs. 19.3% combination therapy vs. captopril, P = 0.005 | Cardiovascular death, MI, CHF HR 0.97 (97.5% CI, 0.89 to 1.05) |
| ON TARGET (32) | 25,560 (3-arm study) | CVD or diabetes with end-organ damage | Telmisartan 80 mg, ramipril 10 mg, or both | Combination vs. ramipril 1.07 (95% CI, 0.98 to 1.16) | 1.04 (95% CI, 0.93 to 1.17) | 0.95 (95% CI, 0.82 to 1.10) | Cardiovascular death, MI or stroke: 0.99 (95% CI, 0.92 to 1.07) |
| COOPERATE (5) | 336 (3-arm study) | Nondiabetic kidney disease with urine protein > 300 mg/day | Losartan 100 mg vs. trandolapril 3 mg vs. both (same doses) | Only 1 death in study (losartan arm) | Only one death, perhaps ruptured abdominal aortic aneurysm | None reported | Stroke/MI, 1 event in each arm |
ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; HR, hazard ratio; CI, confidence interval; CHF, chronic heart failure; EF, ejection fraction; MI, myocardial infarction; CVD, chronic vascular disease.
a
Mean daily dose ACEI was enalapril 17 mg, lisinopril 19 mg, captopril 80 mg, ramipril 6 mg, quinapril 23 mg.
b
Mean daily dose ACEI was enalapril 17 mg, lisinopril 18 mg, captopril 82 mg, ramipril 7 mg.