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Angiotensin receptor blockers may have edge in some elderly

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Compared to angiotensin-converting enzyme (ACE) inhibitors, angiotensin II type 1 receptor blockers (ARBs) appear to reduce mortality in elderly heart failure patients with preserved ejection fraction, researchers report in a September 3rd on-line paper in The American Journal of Cardiology.

Dr. Ali Ahmed told Reuters Health by email, “Although systolic and diastolic heart failure patients have similar symptoms and rather similar outcomes, heart failure drugs seem to work differently in these two groups.”

“If these findings can be replicated in other larger and more contemporary heart failure populations, they may provide much needed evidence to guide therapy for older diastolic heart failure patients, who comprise nearly half of all heart failure patients.”

Dr. Ahmed of the University of Alabama at Birmingham and colleagues examined data on more than 8000 heart failure patients aged 65 years or more who were discharged from 106 Alabama hospitals. In all 3,383 received discharge prescriptions for ACE inhibitors and 661 for ARBs.

The researchers went on to assemble a comparison cohort of 655 pairs of patients balanced in light of 56 baseline characteristics.

During more than 8 years of follow-up, all-cause mortality was 63% in the ARB group and 68% in the ACE patients. This gave a hazard ratio of 0.86 in favor of ARBs.

Further analysis in patients with data on left ventricular ejection fraction (LVEF) showed that this association was significant (hazard ratio, 0.65) only in those with an LVEF of 45% or more. This was not the case in those with a lower LVEF (hazard ratio, 1.0).

There was also a trend towards lower heart failure hospitalization in ARB patients with preserved LVEF (hazard ratio, 0.80) but this did not reach significance.

Commenting on the findings, co-author Dr. Gregg C. Fonarow of the University of California, Los Angeles, added that, “The comparative benefits of two different heart failure medications ACE inhibitors and angiotensin receptor blockers have not been well studied in older patients with heart failure.”

“These findings,” he concluded, “suggest that for older patients with heart failure and preserved ejection fraction, angiotensin receptor blockers may be a better choice than ACE inhibitors.”

This observation, the team concludes, “is intriguing and hypothesis generating and needs to be replicated in other larger propensity-matched heart failure populations.”

A Propensity-Matched Study of the Comparative Effectiveness of Angiotensin Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors in Heart Failure Patients Age ?65 Years

Am J Cardiol 2011.