Physicians' Academy for Cardiovascular Education

Fewer major CV events in patients on ARBs compared to ACEi in high-risk patients

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high vascular risk

Literature - Potier L, Roussel R, Elbez Y, et al. - Heart 2017, Epub ahead of print


Angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEi) are widely used in patients with high cardiovascular (CV) risk. Although both drugs target the same mechanism, it is not clear whether they are similarly effective in prevention of CV events. Regarding this, data available from RCTs and meta-analyses reported conflicting results [1-4]. Both American and European guidelines for the management of patient with CV disease recommend ACEi as a first-choice therapy.

In this study, the effectiveness of ARBs and ACEi were compared using the observational cohort of the REACH registry, including 40 625 outpatients (age ≥45 yrs) with high CV risk and on ARBs (32.1%) or ACEi (67.9%). Primary outcome was the composite of CV mortality, non-fatal myocardial infarction (MI), non-fatal stroke or hospitalisation for CV disease at 4 years.

Main results


Compared to ACEi, ARB use was associated with a lower rate of major CV events in outpatients with high CV risk, which was consistent using two multiple adjustment methods. This difference between ARB and ACEi use was only significant in the subgroup of patients with established atherosclerosis. These results suggest that ARBs should be preferred over ACEIs in patients with a previous history of CV diseases.


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