ABSTRACT: Studies have shown that angiotensin converting enzyme inhibitors (ACEIs) are superior in primary and secondary prevention for cardiac mortality and morbidity to angiotensin receptor blocker (ARBs). One of the common side effects from ACEI is dry cough. The aims of this systematic review, and network meta-analysis are to rank the risk of cough induced by different ACEIs and between ACEI and placebo, ARB or calcium channel blockers (CCB). We performed a systematic review, and network meta-analysis of randomized controlled trials to rank the risk of cough induced by each ACEI and between ACEI and placebo, ARB or CCB. A total of 135 RCTs with 45,420 patients treated with eleven ACEIs were included in the analyses. The pooled estimated relative risk (RR) between ACEI and placebo was 2.21 (95% CI: 2.05-2.39). ACEI had more incidences of cough than ARB (RR 3.2; 95% CI: 2.91, 3.51), and pooled estimated of RR between ACEI and CCB was 5.30 (95% CI: 4.32-6.50) Moexipril ranked as number one for inducing cough (SUCRA 80.4%) and spirapril ranked the least (SUCRA 12.3%). The order for the rest of the ACEIs are as follows: ramipril (SUCRA 76.4%), fosinopril (SUCRA 72.5%), lisinopril (SUCRA 64.7%), benazepril (SUCRA 58.6%), quinapril (SUCRA 56.5%), perindopril (SUCRA 54.1%), enalapril (SUCRA 49.7%), trandolapril (SUCRA 44.6%) and, captopril (SUCRA 13.7%). All ACEI has the similar risk of developing a cough. ACEI should be avoided in patients who have risk of developing cough, and an ARB or CCB is an alternative based on the patient's comorbidity.
ABSTRACT: Antihypertensive drugs are commonly used in cardiovascular diseases (CVD), less is known about the comparative effectiveness of different antihypertensive drugs on stroke events in CVD patients. We searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trails comparing the different antihypertensive drugs for stroke events in CVD patients from inception until November, 2022. Pairwise and network meta-analysis were performed to compare of different antihypertensive drugs for the incidence of stroke events in CVD patients. The protocol was registered on the PROSPERO database (CRD42022375038). 33 trials involving 141,217 CVD patients were included. The incidence of stroke in CVD patients for each antihypertensive drugs was placebo (3.0%), ACEI (2.4%), ARB (4.1%), CCB (1.8%), β blocker (1.3%), and diuretic (3.6%). Antihypertensive drug was significantly reducing stroke events in CVD patients when compared with placebo (OR 0.82; 95% CI 0.75 to 0.89). Specifically, ACEI (OR 0.82; 95% CI 0.69 to 0.97), ARB (OR 0.87; 95% CI 0.77 to 0.98), CCB (OR 0.69; 95% CI 0.54 to 0.87), and diuretic (OR 0.74; 95% CI 0.57 to 0.95) were significantly reducing stroke events in CVD patients when compared with placebo. Network meta-analysis suggested CCB and diuretic ranked the first and second in reducing the incidence of stroke events in CVD patients with the SUCRA value of 90.9% and 73.8%. CCB and diuretic had the greatest possibility to reduce the incidence of stroke events in CVD patients, while, ACEI was the worst antihypertensive agents in reducing the incidence of stroke events in CVD patients.
Background and Purpose The present study aimed to compare the efficacy and tolerability of different blood pressure (BP)-lowering strategies. Methods Randomized controlled trials that compared various antihypertensive treatments and stroke outcomes were included. Eligible trials were categorized into three scenarios: single or combination antihypertensive agents against placebos; single or combination agents against other agents; and different BP-lowering targets. The primary efficacy outcome was the risk reduction pertaining to strokes. The tolerability outcome was the withdrawal of drugs, owing to drug-related side effects (PROSPERO registration number CRD42018118454 [20/12/2018]). Results The present study included 93 trials (average follow-up duration, 3.3 years). In the pairwise analysis, angiotensin-converting enzyme inhibitors (ACEis) and beta-blockers (BBs) were inferior to calcium channel blockers (CCBs) (odds ratio [OR], 1.123; 95% confidence interval [CI], 1.008 to 1.252) (OR, 1.261; 95% CI, 1.116 to 1.425) for stroke prevention, BB was inferior to angiotensin II receptor blockers (ARB) (OR, 1.361; 95% CI, 1.142 to 1.622), and diuretics were superior to ACEi (OR, 0.871; 95% CI, 0.771 to 0.984). The combination of ACEi+CCB was superior to ACEi+diuretic (OR, 0.892; 95% CI, 0.823 to 0.966). The network meta-analysis confirmed that diuretics were superior to BB (OR, 1.34; 95% CI, 1.11 to 1.58), ACEi+diuretic (OR, 1.47; 95% CI, 1.02 to 2.08), BB+C-CB (OR, 2.05; 95% CI, 1.05 to 3.79), and renin inhibitors (OR, 1.87; 95% CI, 1.25 to 2.75) for stroke prevention. Regarding the tolerability profile, the pairwise analysis revealed that ACEi was inferior to CCB and less tolerable, compared to the other treatments. Conclusions Monotherapy using diuretics, CCB, or ARB, and their combinations could be employed as first-line treatments for stroke prevention in terms of efficacy and tolerability.
BACKGROUND: Angiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question. The VALUE trial found an increased risk of myocardial infarction in participants receiving ARBs compared to other antihypertensive. The aim of the meta-analysis was to synthetize the available evidence of randomised controlled trials (RCTs) and elucidate if ARBs increase the risk of cardiovascular events.
METHODS: A comprehensive search was conducted to identify RCTs that assessed the safety of ARBs. Titles and abstracts of all papers were independently screened by two authors. Data extraction and quality assessment were also performed independently. The relative risk (RR) of all-cause mortality, myocardial infarction, and stroke were pooled using the IVhet model. Multiple sensitivity analyses were conducted to assess the effect of ARBs by restricting the analysis to different participants' characteristics.
RESULTS: Forty-five RCTs comprising of 170,794 participants were included in the analysis. The pooled estimates revealed that ARBs do not increase the risk of all-cause mortality (RR 1.00; 95%CI 0.97-1.04), myocardial infarction (RR 1.01; 95%CI 0.96-1.06), and stroke (RR 0.92; 95%CI 0.83-1.01). The sensitivity analysis did not yield a particular group of patients at increased risk of cardiovascular events with ARBs. Risk of all-cause mortality and stroke decreased with ARB when the proportion of smokers in a population was < 25% (RR 0.91; 95%CI 0.84-0.98) and in females (RR 0.76; 95%CI 0.68-0.84), respectively.
CONCLUSIONS: ARBs do not increase the risk of major cardiovascular events and are safe for use in patients.
BACKGROUND: Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD.
OBJECTIVES: This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD.
SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.
SELECTION CRITERIA: We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration.
DATA COLLECTION AND ANALYSIS: Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence.
MAIN RESULTS: One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies.
AUTHORS' CONCLUSIONS: The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
Angiotensin-converting enzyme inhibitors (ACEIs) are considered primary drugs for the secondary prevention of myocardial infarction (MI), and angiotensin receptor blockers (ARBs) are used when ACEIs cannot be tolerated. However, it is unclear whether ACEIs or ARBs are more appropriate first-line drugs in hypertensive patients with MI or heart failure (HF). The present study aimed to compare the effects of ACEIs and those of ARBs in these patients. Sixty randomized controlled trails (RCTs) that compared the effects of ACEIs and ARBs in patients with MI or HF were extracted by searching PubMed/MEDLINE, Cochrane Database, and the Medical Central Journal database according to the PRISMA guidelines. We finally selected six eligible RCTs and identified three systematic reviews and meta-analyses. The proportion of hypertensive patients ranged from 36 to 69%. Meta-analyses were performed for recurrence or new onset of MI (risk ratio 0.97 [95% confidence interval: 0.88, 1.06]), hospitalization for HF (0.98 [0.84, 1.14]), cardiovascular or total mortality (0.98 [0.91, 1.05]), cardiovascular events or stroke (1.02 [0.94, 1.11]), and adverse events (1.40 [1.11, 1.77]). There were no significant differences between ACEIs and ARBs for all outcomes, except adverse events. Study discontinuation owing to adverse events was significantly more common with ACEIs than with ARBs. Among hypertensive patients with MI or HF, it appears desirable to select the most appropriate drugs, ACEIs or ARBs, in each case by considering the function level, patient background, comorbidity presence, blood pressure target, drug price and other such factors comprehensively in addition to considering tolerability.
Antecedentes: Los beneficios de la reducción de la presión arterial tratamiento para la prevención de enfermedades cardiovasculares están bien establecidos. Sin embargo, la medida en que estos efectos difieren según la presión arterial basal, la presencia de comorbilidades o la clase de fármacos es menos clara. Por lo tanto, realizó una revisión sistemática y meta-análisis para aclarar estas diferencias. Para esta revisión sistemática y metanálisis, se realizaron búsquedas en MEDLINE para ensayos a gran escala de reducción de la presión arterial, publicados entre el 1 de enero de 1966 y el 7 de julio de 2015, y se realizaron búsquedas en la literatura médica para identificar los ensayos hasta el 9 de noviembre, 2015. Todos los ensayos controlados aleatorios de tratamiento para disminuir la presión arterial fueron elegibles para inclusión si incluyeron un seguimiento mínimo de 1000 pacientes-año en cada brazo del estudio. No se excluyeron los ensayos debido a la presencia de comorbilidades basales, y los ensayos de fármacos antihipertensivos para otras indicaciones distintas de la hipertensión fueron elegibles. Se extrajeron los datos de nivel de resumen sobre las características del estudio y los resultados de eventos de enfermedades cardiovasculares importantes, enfermedad coronaria, accidente cerebrovascular, insuficiencia cardíaca, insuficiencia renal y mortalidad por todas las causas. Utilizamos metanálisis de efectos fijos ponderados de varianza inversa para agrupar las estimaciones. RESULTADOS: Se identificaron 123 estudios con 613 815 participantes para el metanálisis tabular. Los análisis de metarregresión mostraron reducciones del riesgo relativo proporcionales a la magnitud de las reducciones de la presión arterial logradas. Cada reducción de 10 mm Hg en la presión arterial sistólica redujo significativamente el riesgo de eventos cardiovasculares mayores (riesgo relativo [RR] 0 · 80, IC 95% 0 · 77-0 83], enfermedad coronaria (0,83, 78-0, 88), accidente cerebrovascular (0,73, 0,68-0,77) e insuficiencia cardiaca (0,72, 0,67-0,78), lo que en las poblaciones estudiadas condujo a un aumento significativo 13% de reducción en la mortalidad por todas las causas (0 · 87, 0 · 84-0 · 91). Sin embargo, el efecto sobre la insuficiencia renal no fue significativo (0 · 95, 0 · 84-1 · 07). Se observaron reducciones similares del riesgo proporcional (por 10 mm Hg de presión arterial sistólica más baja) en ensayos con presión arterial sistólica basal media más alta y ensayos con presión arterial sistólica basal media más baja (ptrend> 0,05). No hubo pruebas claras de que las reducciones del riesgo proporcional en las principales enfermedades cardiovasculares diferían por la historia de la enfermedad basal, excepto la diabetes y la enfermedad renal crónica, para los cuales se detectaron reducciones de riesgo menores, pero significativas. Los bloqueadores β fueron inferiores a otros fármacos para la prevención de eventos cardiovasculares mayores, accidentes cerebrovasculares e insuficiencia renal. Los bloqueadores de los canales de calcio fueron superiores a otros fármacos para la prevención del ictus. Para la prevención de la insuficiencia cardíaca, los bloqueadores de los canales de calcio fueron inferiores y los diuréticos fueron superiores a otras clases de fármacos. Se consideró que el riesgo de sesgo era bajo para 113 ensayos y poco claro para 10 ensayos. La heterogeneidad de los resultados fue baja a moderada; La estadística I (2) para la heterogeneidad de eventos cardiovasculares mayores fue de 41%, enfermedad coronaria 25%, accidente cerebrovascular 26%, insuficiencia cardíaca 37%, insuficiencia renal 28% y mortalidad por todas las causas 35%. INTERPRETACIÓN: La disminución de la presión arterial reduce significativamente el riesgo vascular a través de diversos niveles de presión arterial y comorbilidades. Nuestros resultados proporcionan un fuerte apoyo para bajar la presión arterial a presiones arteriales sistólicas de menos de 130 mm Hg y proporcionar tratamiento de reducción de la presión arterial a personas con antecedentes de enfermedad cardiovascular, enfermedad coronaria, accidente cerebrovascular, diabetes, insuficiencia cardíaca y enfermedad renal crónica. FINANCIAMIENTO: Instituto Nacional de Investigación en Salud y Escuela Oxford Martin.
ANTECEDENTES: El sistema renina-angiotensina-aldosterona (SRAA) bloqueadores son terapias efectivas para la insuficiencia cardíaca y la reducción de la fracción de eyección (ICFER) o disfunción ventricular izquierda (LVD). El objetivo fue evaluar la eficacia y seguridad de los bloqueadores del SRAA en estos pacientes.
MÉTODOS: Se realizaron búsquedas en MEDLINE, EMBASE y Cochrane Library de mayo de de 2015. Veintiún ensayos controlados aleatorios doble ciego (ECA) con 69,229 pacientes fueron incluidos esta red metanálisis.
RESULTADOS: En comparación con el placebo, un inhibidor del receptor de la angiotensina-neprilisina (ARNI) tenía la mayor probabilidad de reducir la mortalidad por todas las causas (odds ratio [OR] = 0,67, 95% intervalo de credibilidad [CRI]: 0,48-0,86), seguido de una antagonista del receptor de aldosterona (ARA, OR = 0,74, 95% CRI: 0,62 hasta 0,88) y un inhibidor de la enzima convertidora de angiotensina (IECA, OR = 0,80, 95% CRI: desde 0,71 hasta 0,89). La terapia más eficaz para prevenir hospitalización por insuficiencia cardiaca fue ARNI (OR = 0,55, 95% CRI: 0,40 a 0,71), seguido de terapia de combinación con un bloqueador del receptor de angiotensina II (ARB), además de un IECA (OR = 0,61, 95% CRI: 0,49-0,75), a continuación, un IECA solos (OR = 0,69, 95% CRI: 0,61-0,77). El análisis de sensibilidad restringido a los nueve ECA con un alto uso de fondo de los IECA y / o ARA (> 80%) indicó que la adición de un ARA a la terapia estándar actual reduce significativamente la mortalidad (OR = 0,73, 95% CRI: 0,51-0,95) y el riesgo de hospitalización (OR = 0,67, 95% CRI: 0,47 a 0,87), pero no aumentó significativamente el riesgo de interrupción (OR = 1,29, 95% CRI: 0,83 a 2,31).
CONCLUSIONES: ARNI tiene la mayor probabilidad de ser la terapia más eficaz para ICFER en la reducción de muerte y hospitalización por insuficiencia cardiaca. ARA tiene el perfil riesgo-beneficio más favorable como un complemento de fondo IECA y / o terapia ARB.
La eficacia y la seguridad de los bloqueadores de los receptores de angiotensina (ARB) en la población de edad avanzada no está clara. OBJETIVOS: Determinar la eficacia y seguridad de ARBs en pacientes de edad avanzada. MÉTODOS: Se incluyeron ensayos aleatorios que compararon ARBs con el control y reportaron resultados clínicos en pacientes con una edad media de 65 años o más. Se construyeron índices de riesgo sumario (RR) de efectos aleatorios. RESULTADOS: Un total de 16 ensayos cumplieron con los criterios de selección, que arrojaron 113,386 pacientes. Los ARBs se asociaron con un aumento marginal del riesgo de mortalidad por todas las causas (RR: 1,03, intervalo de confianza del 95%: 1,00-1,06, P = 0,05), un aumento no significativo del riesgo de infarto de miocardio (RR: 1,04, IC del 95% : 0,96-1,12, P = 0,36), una reducción marginal de la hospitalización por insuficiencia cardíaca (RR: 0,86, IC del 95%: 0,74-1,00, P = 0,06) y una reducción significativa del riesgo de accidente cerebrovascular (RR: 0,93; % CI: 0,87 - 0,99, P = 0,03). Los ARBs se asociaron con un aumento del riesgo de lesión renal aguda (RR: 1,48, IC del 95%: 1,24-1,77, P <0,001), hipotensión (RR: 1,56, IC del 95%: 1,24-1,97, P <0,001) e hiperpotasemia (RR: 1,57, IC del 95%: 1,13 - 2,19, P = 0,008). En el análisis de sensibilidad, incluidos los ensayos controlados con placebo, el riesgo de mortalidad por todas las causas ya no era significativo (P = 0,2), mientras que el resto de los resultados no cambiaban. Conclusión: En pacientes de edad avanzada, el beneficio de los ARB en comparación con el control fue más fuerte para la reducción del ictus, sin asociaciones (o débiles) de mortalidad por todas las causas, infarto de miocardio e insuficiencia cardiaca. El beneficio fue compensado por un mayor riesgo de lesión renal aguda, hipotensión e hiperpotasemia. Por lo tanto, los ARB deben utilizarse con precaución en los pacientes de edad avanzada cuando estén clínicamente indicados.
El angioedema es una evento adverso poco común y potencialmente mortal de los inhibidores del sistema renina-angiotensina. El objetivo del presente estudio fue determinar el riesgo de angioedema a partir de ensayos clínicos aleatorios. Se realizó una búsqueda en PubMed, CENTRAL y EMBASE de ensayos clínicos aleatorios a partir de 1980 a octubre de 2011 en pacientes en tratamiento con inhibidores de la enzima convertidora de angiotensina (IECA), antagonistas del receptor de angiotensina II (ARA II), o inhibidores directos de renina (IDR). Ensayos con un número total de pacientes ≥ 100 y una duración de ≥ 8 semanas fueron incluidos en el análisis. La incidencia de angioedema se agrupó por peso de la tasa de incidencia de cada ensayo por la inversa de la varianza. Veintiséis ensayos con 74.857 pacientes en el grupo de inhibidores de la ECA con 232.523 persona-años de seguimiento, 19 ensayos con 35.479 pacientes en ARA II con 122.293 persona-años de seguimiento, y 2 ensayos con 5.141 pacientes en IDR con 1.735 persona-años de seguimiento, cumplieron los criterios de inclusión y fueron incluidos en el análisis. En comparación cabeza a cabeza en 7 ensayos, el riesgo de angioedema con IECA fue 2,2 veces mayor que con ARA II (intervalo de confianza [IC] 95% 1,5 a 3,3). Con inhibidores de la ECA y ARA II, la incidencia de angioedema fue mayor en los ensayos de insuficiencia cardiaca en comparación con ensayos de hipertensión o enfermedad de la arteria coronaria sin insuficiencia cardíaca (p <0,0001). La incidencia ponderada de angioedema con los IECA fue de 0,30% (IC 95%: 0,28 a 0,32) en comparación con 0,11% (IC 95%: 0,09 a 0,13) con ARA II, 0,13% (IC 95%: 0,08 a 0,19) con IDR, y 0,07% con placebo (IC 95%: 0,05 a 0,09). En conclusión, la incidencia de angioedema con ARA II y IDR fue <1/2 que con los inhibidores de la ECA y no significativamente diferentes del placebo. La incidencia de angioedema fue mayor en pacientes con insuficiencia cardiaca en comparación con aquellos sin insuficiencia cardíaca con IECA y ARA II.
Studies have shown that angiotensin converting enzyme inhibitors (ACEIs) are superior in primary and secondary prevention for cardiac mortality and morbidity to angiotensin receptor blocker (ARBs). One of the common side effects from ACEI is dry cough. The aims of this systematic review, and network meta-analysis are to rank the risk of cough induced by different ACEIs and between ACEI and placebo, ARB or calcium channel blockers (CCB). We performed a systematic review, and network meta-analysis of randomized controlled trials to rank the risk of cough induced by each ACEI and between ACEI and placebo, ARB or CCB. A total of 135 RCTs with 45,420 patients treated with eleven ACEIs were included in the analyses. The pooled estimated relative risk (RR) between ACEI and placebo was 2.21 (95% CI.: 2.05-2.39). ACEI had more incidences of cough than ARB (RR 3.2; 95% CI.: 2.91, 3.51), and pooled estimated of RR between ACEI and CCB was 5.30 (95% CI.: 4.32-6.50) Moexipril ranked as number one for inducing cough (SUCRA 80.4%) and spirapril ranked the least (SUCRA 12.3%). The order for the rest of the ACEIs are as follows: ramipril (SUCRA 76.4%), fosinopril (SUCRA 72.5%), lisinopril (SUCRA 64.7%), benazepril (SUCRA 58.6%), quinapril (SUCRA 56.5%), perindopril (SUCRA 54.1%), enalapril (SUCRA 49.7%), trandolapril (SUCRA 44.6%) and, captopril (SUCRA 13.7%). All ACEI has the similar risk of developing a cough. ACEI should be avoided in patients who have risk of developing cough, and an ARB or CCB is an alternative based on the patient's comorbidity.
Pregunta de la revisión sistemática»Revisión sistemática de intervenciones
