SynthesisBMJ (Clinical research ed.)2011
Angiotensin receptor blockers and risk of myocardial infarction: meta-analyses and trial sequential analyses of 147 020 patients from randomised trials.
Synthesis in BMJ (Clinical research ed.), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 9 syntheses or guidelines pooled it, 137 citations in OpenAlex.
- A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta-analysis with trial sequential analysis.Journal of clinical hypertension (Greenwich, Conn.) · 2023Pooled it
- Benefits and Risks Associated with Low-Dose Aspirin Use for the Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2022Pooled it
- Safety and Efficacy of Double Antithrombotic Therapy With Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2020Pooled it
- Assessing the risk of angiotensin receptor blockers on major cardiovascular events: a systematic review and meta-analysis of randomized controlled trials.BMC cardiovascular disorders · 2020Pooled it
- Pooled it
- Cardiovascular and Renal Outcomes of Renin-Angiotensin System Blockade in Adult Patients with Diabetes Mellitus: A Systematic Review with Network Meta-Analyses.PLoS medicine · 2016Pooled it
- Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis.BMJ (Clinical research ed.) · 2015Pooled it
- Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies.BMC cardiovascular disorders · 2014Pooled it
- Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients.European heart journal · 2012Pooled it
- Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension and diabetes mellitus: results from the PREVER-treatment randomized controlled trial.Acta diabetologica · 2021Trial
- Hypertension Treatment with Angiotensin Receptor Blockers and Other Antihypertensive Agents: A Real-World Registry from a High-Volume Specialized Center Over TwoDecades.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Observational
- Prolylcarboxypeptidase Alleviates Hypertensive Cardiac Remodeling by Regulating Myocardial Tissue Angiotensin II.Journal of the American Heart Association · 2023Article
- Comparison of cardiocerebrovascular disease incidence between angiotensin converting enzyme inhibitor and angiotensin receptor blocker users in a real-world cohort.Journal of applied biomedicine · 2023Article
- Long-Term Prognosis of Patients with Heart Failure: Follow-Up Results of Journey HF-TR Study Population.Anatolian journal of cardiology · 2023Article
- Article
- Angiotensin Receptor Blockers in the Management of Hypertension: A Real-World Perspective and Current Recommendations.Vascular health and risk management · 2022Review
- Comparative First-Line Effectiveness and Safety of ACE (Angiotensin-Converting Enzyme) Inhibitors and Angiotensin Receptor Blockers: A Multinational Cohort Study.Hypertension (Dallas, Tex. : 1979) · 2021Article
- An ACE inhibitor reduces bactericidal activity of human neutrophils in vitro and impairs mouse neutrophil activity in vivo.Science translational medicine · 2021Article
- Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers might be associated with lung adenocarcinoma risk: a nationwide population-based nested case-control study.American journal of translational research · 2020Article
- Efficacy and toxicity of antihypertensive pharmacotherapy relative to effective dose 50.British journal of clinical pharmacology · 2019Review
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the cardiovascular outcomes and other outcomes associated with angiotensin receptor blockers.
designSystematic review of randomised controlled trials with meta-analysis and trial sequential analysis (TSA). DATA SOURCES AND STUDY SELECTION: Pubmed, Embase, and CENTRAL searches for randomised clinical trials, until August 2010, of angiotensin receptor blockers compared with controls (placebo/active treatment) that enrolled at least 100 participants and had a follow-up of at least one year. DATA EXTRACTION: Myocardial infarction, death, cardiovascular death, angina pectoris, stroke, heart failure, and new onset diabetes.
results37 randomised clinical trials included 147,020 participants and had a total follow-up of 485,166 patient years. When compared with controls (placebo/active treatment), placebo, or active treatment, angiotensin receptor blockers were not associated with an increase in the risk of myocardial infarction (relative risk 0.99, 95% confidence interval 0.92 to 1.07), death, cardiovascular death, or angina pectoris. Compared with controls, angiotensin receptor blockers were associated with a reduction in the risk of stroke (0.90, 0.84 to 0.98), heart failure (0.87, 0.81 to 0.93), and new onset diabetes (0.85, 0.78 to 0.93), with similar results when compared with placebo or with active treatment. Based on trial sequential analysis, there is no evidence even for an average 5.0-7.5% (upper confidence interval 5-11%) relative increase in myocardial infarction (absolute increase of 0.3%), death, or cardiovascular death with firm evidence for relative risk reduction of stroke (at least 1%, average 10%) (compared with placebo only), heart failure (at least 5%, average 10%), and new onset diabetes (at least 4%, average 10%) with angiotensin receptor blockers compared with controls.
conclusionsThis large and comprehensive analysis produced firm evidence to refute the hypothesis that angiotensin receptor blockers increase the risk of myocardial infarction (ruling out even a 0.3% absolute increase). Compared with controls, angiotensin receptor blockers reduce the risk of stroke, heart failure, and new onset diabetes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.