Individual Effects of Angiotensin II Receptor Blockers on Major Adverse Cardiovascular Events: A Systematic Review and Network Meta-Analysis.
Eurico Joaquim Lutucuta Ernesto, Ana Claudia Cavalcante Nogueira, Luis Gustavo Sedenho-Prado et al.
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In 30 seconds
This systematic review and random-effects network meta-analysis compared angiotensin II receptor blockers (ARBs) for cardiovascular outcomes in randomized trials not primarily designed to study heart failure. It included 27 trials and 702,584 patient-years, excluding studies focused mainly on patients with pre-existing heart failure. Candesartan was associated with lower odds of major adverse cardiovascular events (MACE) than placebo (OR 0.79; 95% CI, 0.63-0.97), and telmisartan also showed a significant reduction (OR 0.90; 95% CI, 0.80-0.99). Candesartan ranked highest among the ARBs, but many comparisons were indirect.
Key findings
- Candesartan reduced MACE versus placebo (OR 0.79; 95% CI, 0.63-0.97; SUCRA=0.85).
- Telmisartan also reduced MACE versus placebo (OR 0.90; 95% CI, 0.80-0.99; SUCRA=0.61).
- The network meta-analysis included 27 randomized trials and 702,584 patient-years.
Why it matters
The findings suggest that cardiovascular outcome effects may differ among ARBs, rather than being uniform across the class. This may inform interpretation of comparative evidence when considering cardiovascular risk reduction. However, the predominance of indirect comparisons means the apparent differences between individual drugs are uncertain and should not be treated as definitive evidence of superiority.
What to keep in mind
The analysis used study-level data and moderately sparse treatment networks, with predominantly indirect comparisons between ARBs.