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Ventricular Dysfunction Therapy Linked to Adverse Effects

Combined treatment with ARBs and ACE inhibitors increases risk

FRIDAY, Oct. 12 (HealthDay News) -- Combined treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors for symptomatic left ventricular dysfunction increases the risk of adverse effects compared with ACE inhibitors alone, researchers report in the Oct. 8 issue of the Archives of Internal Medicine.

Christopher O. Phillips, M.D., from the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio, and colleagues performed a meta-analysis of four studies of randomized controlled trials (involving 17,337 patients) examining combined treatment with ARBs and ACE inhibitors for symptomatic left ventricular dysfunction. The mean follow-up was 25 months.

The researchers found that compared with controls receiving standard therapy that included an ACE inhibitor, combination treatment was more likely to lead to medication discontinuation due to adverse effects in patients with chronic heart failure (relative risk 1.38) or myocardial infarction (RR, 1.17). These patients were also at higher risk of worsening renal function, hyperkalemia and symptomatic hypotension.

"The results of our systematic review are consistent with current heart failure guidelines that have expressed reservations about a routine strategy for dual angiotensin inhibition using ARBs plus ACE inhibitors," the authors conclude.

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