BACKGROUND: Between 5% and 20% of patients treated with angiotensin-converting enzyme inhibitors (ACE inhibitors) develop intolerance. Angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) can be used as an alternative treatment. OBJECTIVE: In this study we aimed to evaluate the tolerability of ARBs in patients with intolerance to ACE inhibitors. DATA SOURCES: The electronic databases PubMed, MEDLINE/EMBASE via Dialog, CENTRAL, and ISI Web of Knowledge were searched. STUDY SELECTION: Randomized controlled trials (RCTs) evaluating ARBs in patients with intolerance to ACE inhibitors were selected. DATA SYNTHESIS: Risk ratio (RR) and 95% confidence intervals (CIs) were estimated assuming the random effects method. We found 11 RCTs comparing ARBs with ACE inhibitors, diuretics, or placebo, and one RCT comparing high-dose versus low-dose ARB. RESULTS: ARBs had fewer cough events versus ACE inhibitors (RR 0.37; 95% CI 0.28, 0.48). ARBs had drug discontinuation (RR 0.99; 95% CI 0.84, 1.17) and cough risk (RR 1.01; 95% CI 0.74, 1.39) rates similar to placebo. Angioedema risk with ARBs was also similar to placebo (RR 1.62; 95% CI 0.17, 15.79). Compared with placebo, hypotension (RR 2.63; 95% CI 1.77, 3.92), renal dysfunction (RR 2.07; 95% CI 1.45, 2.95) and hyperkalemia (RR 3.37; 95% CI 1.60, 7.11) were more frequent with ARBs. CONCLUSIONS: ACE inhibitor rechallenge should be discouraged in patients with previous intolerance to ACE inhibitors due to a higher risk of cough. ARBs had cough and angioedema incidences similar to placebo. Despite a significantly higher incidence of hypotension, renal dysfunction and hyperkalemia, discontinuation of ARBs was similar to placebo.
BACKGROUND: Between 5% and 20% of patients treated with angiotensin-converting enzyme inhibitors (ACE inhibitors) develop intolerance. Angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) can be used as an alternative treatment. OBJECTIVE: In this study we aimed to evaluate the tolerability of ARBs in patients with intolerance to ACE inhibitors. DATA SOURCES: The electronic databases PubMed, MEDLINE/EMBASE via Dialog, CENTRAL, and ISI Web of Knowledge were searched. STUDY SELECTION: Randomized controlled trials (RCTs) evaluating ARBs in patients with intolerance to ACE inhibitors were selected. DATA SYNTHESIS: Risk ratio (RR) and 95% confidence intervals (CIs) were estimated assuming the random effects method. We found 11 RCTs comparing ARBs with ACE inhibitors, diuretics, or placebo, and one RCT comparing high-dose versus low-dose ARB. RESULTS: ARBs had fewer cough events versus ACE inhibitors (RR 0.37; 95% CI 0.28, 0.48). ARBs had drug discontinuation (RR 0.99; 95% CI 0.84, 1.17) and cough risk (RR 1.01; 95% CI 0.74, 1.39) rates similar to placebo. Angioedema risk with ARBs was also similar to placebo (RR 1.62; 95% CI 0.17, 15.79). Compared with placebo, hypotension (RR 2.63; 95% CI 1.77, 3.92), renal dysfunction (RR 2.07; 95% CI 1.45, 2.95) and hyperkalemia (RR 3.37; 95% CI 1.60, 7.11) were more frequent with ARBs. CONCLUSIONS:ACE inhibitor rechallenge should be discouraged in patients with previous intolerance to ACE inhibitors due to a higher risk of cough. ARBs had cough and angioedema incidences similar to placebo. Despite a significantly higher incidence of hypotension, renal dysfunction and hyperkalemia, discontinuation of ARBs was similar to placebo.
Authors: C Custodero; R T Mankowski; S A Lee; Z Chen; S Wu; T M Manini; J Hincapie Echeverri; C Sabbà; D P Beavers; J A Cauley; M A Espeland; R A Fielding; S B Kritchevsky; C K Liu; M M McDermott; M E Miller; R P Tracy; A B Newman; W T Ambrosius; M Pahor; S D Anton Journal: Ageing Res Rev Date: 2018-05-25 Impact factor: 10.895
Authors: Cheng Gang; Christopher J Lindsell; Joseph Moellman; Wesley Sublett; Kim Hart; Sean Collins; Jonathan A Bernstein Journal: Allergy Asthma Proc Date: 2013 May-Jun Impact factor: 2.587
Authors: M Wadelius; S E Marshall; G Islander; L Nordang; M Karawajczyk; Q-Y Yue; I Terreehorst; E V Baranova; S Hugosson; K Sköldefors; M Pirmohamed; A-H Maitland-van der Zee; A Alfirevic; P Hallberg; C N A Palmer Journal: Clin Pharmacol Ther Date: 2014-06-24 Impact factor: 6.875