TY - JOUR
T1 - Efficacy and safety of angiotensin receptor blockers in older patients
T2 - A meta-analysis of randomized trials
AU - Elgendy, Islam Y.
AU - Huo, Tianyao
AU - Chik, Veronica
AU - Pepine, Carl J.
AU - Bavry, Anthony A.
N1 - Publisher Copyright:
© Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2014.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background The efficacy and safety of angiotensin receptor blockers (ARBs) in the older population is unclear. Objectives To determine the efficacy and safety of ARBs in older patients. Methods Randomized trials that compared ARBs to control and reported clinical outcomes in patients with a mean age of 65 years or older were included. Random-effects summary risk ratios (RRs) were constructed. Results A total of 16 trials met our selection criteria, which yielded 113,386 patients. ARBs were associated with a marginal increased risk of allcause mortality (RR: 1.03, 95% confidence interval (CI): 1.00-1.06, P = 0.05), a nonsignificant increased risk of myocardial infarction (RR: 1.04, 95% CI: 0.96-1.12, P = 0.36), a marginal reduction in heart failure hospitalization (RR: 0.86, 95% CI: 0.74-1.00, P = 0.06), and a significant reduction in the risk of stroke (RR: 0.93, 95% CI: 0.87-0.99, P = 0.03). ARBs were associated with an increased risk of acute kidney injury (RR: 1.48, 95% CI: 1.24-1.77, P < 0.001), hypotension (RR: 1.56, 95% CI: 1.24-1.97, P < 0.001), and hyperkalemia (RR: 1.57, 95% CI: 1.13-2.19, P = 0.008). On the sensitivity analysis including placebo-controlled trials, the risk of all-cause mortality was no longer significant (P = 0.2), while the remainder of the outcomes did not change. Conclusion In older patients, the benefit of ARBs compared with control was strongest for stroke reduction, with no (or weak) associations for allcause mortality, myocardial infarction, and heart failure hospitalization. Benefit was offset by an increased risk of acute kidney injury, hypotension, and hyperkalemia. Thus, ARBs should be used with caution in older patients when clinically indicated.
AB - Background The efficacy and safety of angiotensin receptor blockers (ARBs) in the older population is unclear. Objectives To determine the efficacy and safety of ARBs in older patients. Methods Randomized trials that compared ARBs to control and reported clinical outcomes in patients with a mean age of 65 years or older were included. Random-effects summary risk ratios (RRs) were constructed. Results A total of 16 trials met our selection criteria, which yielded 113,386 patients. ARBs were associated with a marginal increased risk of allcause mortality (RR: 1.03, 95% confidence interval (CI): 1.00-1.06, P = 0.05), a nonsignificant increased risk of myocardial infarction (RR: 1.04, 95% CI: 0.96-1.12, P = 0.36), a marginal reduction in heart failure hospitalization (RR: 0.86, 95% CI: 0.74-1.00, P = 0.06), and a significant reduction in the risk of stroke (RR: 0.93, 95% CI: 0.87-0.99, P = 0.03). ARBs were associated with an increased risk of acute kidney injury (RR: 1.48, 95% CI: 1.24-1.77, P < 0.001), hypotension (RR: 1.56, 95% CI: 1.24-1.97, P < 0.001), and hyperkalemia (RR: 1.57, 95% CI: 1.13-2.19, P = 0.008). On the sensitivity analysis including placebo-controlled trials, the risk of all-cause mortality was no longer significant (P = 0.2), while the remainder of the outcomes did not change. Conclusion In older patients, the benefit of ARBs compared with control was strongest for stroke reduction, with no (or weak) associations for allcause mortality, myocardial infarction, and heart failure hospitalization. Benefit was offset by an increased risk of acute kidney injury, hypotension, and hyperkalemia. Thus, ARBs should be used with caution in older patients when clinically indicated.
KW - Angiotensin receptor blockers
KW - Blood pressure
KW - Elderly
KW - Heart failure
KW - Hypertension
KW - Meta-analysis
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U2 - 10.1093/ajh/hpu209
DO - 10.1093/ajh/hpu209
M3 - Article
C2 - 25391580
AN - SCOPUS:84934285741
SN - 0895-7061
VL - 28
SP - 576
EP - 585
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 5
ER -