According to the findings of a meta-analysis published early online in the European Heart Journal, ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have a beneficial effect for the prevention of heart failure over and above that of blood pressure reduction, and this benefit is of larger magnitude than that associated with calcium channel blockers (CCBs).   

The authors conducted a meta-analysis of trials comparing ACEIs, ARBs, or CCBs, with diuretics, beta-blockers, or placebo in hypertensive or high-risk subjects without congestive heart failure (CHF) at entry.  In placebo-controlled trials, ACEIs were associated with a 21% reduction in the risk of CHF (P = 0.007), whereas the effect of ARBs and CCBs was not statistically significant.  No differences were found with ACEIs in comparative trials, i.e. ACEIs were not superior to diuretics/beta-blockers for the prevention of CHF [odds ratio (OR) 1.02; 95% CI 0.84–1.24].  CCBs were however associated with an 18% higher risk of CHF (OR 1.18; 95% CI 1.00–1.39; P = 0.048). 

Due to significant heterogeneity between the trials, the authors investigated potential sources of heterogeneity by meta-regression.  They found that:

• The risk of CHF decreased by 24% (P < 0.001) for each 5 mmHg reduction in systolic BP
• The risk of CHF was 19% less with ACEIs/ARBs than CCBs (P<0.001) and 16% less in studies without multiple risk factors required for entry (P = 0.009).

[Please note: this report was taken from the abstract only; no further details on the study are presented].