Table 2. Cardiovascular outcomes: comparisons of random effects pairwise meta-analysis with Bayesian network meta-analysis, including confidence of assessments.
| Outcome | Treatment | Number of Studies with Direct Comparison to ACEi (Participants) | Pairwise Meta-analysis OR (95% CI); Quality of Evidence | I 2 (95% CI) | Cochran’s Q p-Value | Network Meta-analysis OR (95% CrI); Quality of Evidence |
|---|---|---|---|---|---|---|
| Major cardiovascular outcome | ACEi (reference) | |||||
| ARB | 5 (13,480) | 0.93 (0.77–1.13); Moderate | 62.3% (0.0–82.0) | 0.03 | 1.02 (0.90–1.18); Moderate | |
| ACEi + ARB | 3 (9,046) | 0.95 (0.85–1.05); Moderate | 0.0% (0.0–90.0) | 0.85 | 0.97 (0.79–1.19); Moderate | |
| DRi + ACEi | 1 (3,790) | 1.09 (0.90–1.34); Low | — | — | 1.32 (0.96–1.81); Low | |
| DRi + ARB | 1 (4,217) | 0.83 (0.68–1.02); Low | — | — | 1.00 (0.73–1.38); Low | |
| DRi + diuretic | 0 (0) | — | — | — | 1.07 (0.63–1.91); Very low | |
| ACEi + diuretic | 0 (0) | — | — | — | 1.05 (0.75–1.52); Very low | |
| ACEi + CCB | 1 (206) | 0.54 (0.15–1.91); Very low | — | — | 0.47 (0.12–1.41); Very low | |
| Cardiovascular mortality | ACEi (reference) | |||||
| ARB | 5 (13,480) | 0.97 (0.78–1.23): Moderate | 60.7% (0.0–85.0) | 0.04 | 1.00 (0.82–1.23); Moderate | |
| ACEi + ARB | 3 (9,046) | 1.03 (0.86–1.22); Moderate | 29.6% (0.0–93.0) | 0.24 | 1.06 (0.79–1.49); Moderate | |
| DRi + ACEi | 1 (3,790) | 1.18 (0.91–1.52); Low | — | — | 1.45 (0.91–2.35); Low | |
| DRi + ARB | 1 (4,217) | 0.80 (0.61–1.04); Low | — | — | 0.98 (0.61–1.60); Low | |
| DRi + diuretic | 0 (0) | — | — | — | 1.32 (0.63–2.84); Very low | |
| ACEi + diuretic | 0 (0) | — | — | — | 0.81 (0.49–1.36); Very low | |
| ARB + diuretic | 0 (0) | — | — | — | 0.71 (0.02–14.19); Very low | |
| ACEi + CCB | 1 (206) | 0.49 (0.04–5.44); Very low | — | — | 0.15 (0.01–0.88); Very low | |
| ARB + CCB | 0 (0) | — | — | — | 0.41 (0.02–5.75); Very low | |
| Myocardial infarction | ACEi (reference) | |||||
| ARB | 5 (13,480) | 0.98 (0.78–1.23); Moderate | 48.3% (0.0–81.0) | 0.10 | 1.07 (0.89–1.28); Moderate | |
| ACEi + ARB | 3 (9,046) | 0.94 (0.81–1.10); Moderate | 0.0% (0.0–90.0) | 0.69 | 1.00 (0.78–1.33); Moderate | |
| DRi + ACEi | 1 (3,790) | 1.10 (0.80–1.52); Low | — | — | 1.35 (0.85–2.12); Low | |
| DRi + ARB | 1 (4,217) | 0.68 (0.48–0.95); Low | — | — | 0.83 (0.52–1.31); Low | |
| DRi + diuretic | 0 (0) | — | — | — | 0.61 (0.24–1.60); Very low | |
| ARB + diuretic | 0 (0) | — | — | — | 3.06 (0.37–39.80); Very low | |
| ACEi + CCB | 1 (206) | 0.32 (0.03–3.13); Very low | — | — | 0.45 (0.06–2.18); Very low | |
| ARB + CCB | 0 (0) | — | — | — | 1.45 (0.21–14.40); Very low | |
| Stroke | ACEi (reference) | |||||
| ARB | 6 (13,522) | 0.93 (0.79–1.09); Moderate | 0.0% (0.0–75.0) | 0.96 | 1.01 (0.88–1.16); Moderate | |
| ACEi + ARB | 4 (9,100) | 0.86 (0.71–1.04); Moderate | 0.0% (0.0–85.0) | 0.58 | 0.88 (0.71–1.08); Moderate | |
| DRi + ACEi | 1 (3,790) | 1.09 (0.76–1.56); Low | — | — | 1.19 (0.82–1.67); Low | |
| DRi + ARB | 1 (4,217) | 1.18 (0.84–1.66); Low | — | — | 1.28 (0.91–1.78); Low | |
| DRi + diuretic | 0 (0) | — | — | — | 0.45 (0.16–1.20); Very low | |
| ACEi + diuretic | 0 (0) | — | — | — | 1.05 (0.81–1.41); Very low | |
| ARB + diuretic | 0 (0) | — | — | — | 0.75 (0.19–2.90); Very low | |
| ACEi + CCB | 1 (206) | 0.32 (0.03–3.13); Very low | — | — | 0.31 (0.01–2.30); Very low | |
| ARB + CCB | 0 (0) | — | — | — | 1.21 (0.40–3.67); Very low | |
| Angina pectoris | ACEi (reference) | |||||
| ARB | 3 (9,046) | 1.03 (0.80–1.31); Moderate | 57.0% (0.0–88.0) | 0.10 | 1.14 (0.98–1.37); Moderate | |
| ACEi + ARB | 4 (10,231) | 0.98 (0.79–1.21); Moderate | 48.5% (0.0–83.0) | 0.12 | 1.00 (0.82–1.23); Moderate | |
| DRi + ACEi | 0 (0) | — | — | — | NA | |
| DRi + ARB | 0 (0) | — | — | — | NA | |
| DRi + diuretic | 0 (0) | — | — | — | 1.32 (0.56–3.17); Very low | |
| ACEi + diuretic | 0 (0) | — | — | — | NA | |
| ARB + diuretic | 0 (0) | — | — | — | 9.81 (0.27–564.0); Very low | |
| ACEi + CCB | 0 (0) | — | — | — | NA | |
| ARB + CCB | 0 (0) | — | — | — | 3.25 (0.28–89.45); Very low | |
| Hospitalization for heart failure | ACEi (reference) | |||||
| ARB | 5 (13,480) | 0.99 (0.81–1.21); Moderate | 48.1% (0.0–81.0) | 0.10 | 0.99 (0.86–1.12); Moderate | |
| ACEi + ARB | 5 (10,284) | 0.91 (0.80–1.03); Moderate | 0.0% (0.0–79.0) | 0.71 | 0.86 (0.73–1.01); Moderate | |
| DRi + ACEi | 1 (3,790) | 0.91 (0.69–1.20); Low | — | — | 1.06 (0.75–1.45); Low | |
| DRi + ARB | 1 (4,217) | 0.72 (0.54–0.94); Low | — | — | 0.83 (0.59–1.14); Low | |
| DRi + diuretic | 0 (0) | - | — | — | 1.05 (0.65–1.70); Very low | |
| ACEi + diuretic | 1 (54) | 5.39 (0.25–117.77); Very low | — | — | 2.02 (0.22–22.89); Very low | |
| ARB + diuretic | 0 (0) | — | — | — | 0.37 (0.05–2.43); Very low | |
| ACEi + CCB | 0 (0) | — | — | — | NA | |
| ARB + CCB | 0 (0) | — | — | — | 0.55 (0.10–2.23); Very low |
An OR > 1 favors the ACE inhibitor (i.e., fewer events occur with the ACE inhibitor than with the other active agent).
ACEi, ACE inhibitor; DRi, DR inhibitor; NA, not applicable.