Angiotensin II receptor blockers and myocardial infarction: An updated analysis of randomized clinical trials

Massimo Volpe, Giuliano Tocci, Sebastiano Sciarretta, Paolo Verdecchia, Bruno Trimarco, Giuseppe Mancia

Research output: Contribution to journalArticlepeer-review


Objective To evaluate the effects of treatments based on angiotensin II receptor blockers (ARBs) on the risk of myocardial infarction (MI), cardiovascular and all-cause death, as compared with conventional treatment or placebo. Methods We performed a meta-analysis of all available major international, randomized clinical trials (20 trials, n = 108 909 patients, mean age 66.5 ± 4.1 years), published by 31 August 2008, comparing ARBs with other drugs or conventional therapies (placebo) and reporting MI incidence. Results During a mean follow-up of 3.3 ± 1.1 years, a total of 2374/53 208 and 2354/53153 cases of MI were recorded in ARB-based groups and in comparator arms, respectively [odds ratio (OR) 95% confidence interval (CI) 1.008 (0.950-1.069)]. Risks of MI were not different when tested in different clinical conditions, including hypertension, high cardiovascular risk, stroke, coronary disease, renal disease and heart failure. No significant differences in the risk of MI between treatment with ARBs versus placebo [OR 95% CI 0.944 (0.841-1.060)], beta-blockers and diuretics [OR 95% CI 0.970 (0.804-1.170)], calcium channel blockers [OR 95% CI1.112 (0.971-1.272)], or angiotensin- converting enzyme (ACE) inhibitors [OR 95% CI 1.008 (0.926-1.099)] were observed. Analysis of trials comparing combination therapy based on ARBs plus ACE inhibitors versus active treatments or placebo showed equivalent MI risk [OR 95% CI 0.996 (0.896-1.107)]. Conclusion The present meta-analysis indicates that the risk of MI is comparable with use of ARBs and other antihypertensive drugs in a wide range of clinical conditions.

Original languageEnglish
Pages (from-to)941-946
Number of pages6
JournalJournal of Hypertension
Issue number5
Publication statusPublished - May 2009


  • Acute myocardial infarction
  • Angiotensin II receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Cardiovascular disease
  • Clinical trials
  • Hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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