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CAN ANGIOTENSIN RECEPTOR BLOCKERS (ARBS) INCREASE HEART
ATTACKS? NEW INFORMATION FROM THE BRITISH MEDICAL JOURNAL
Dateline: December 30, 2004 ... Toronto, Ontario, Canada
Contact Name: Linda Gawad, Cardiothoracic Research Group
Contact Phone: 416-340-4580
TORONTO, ONTARIO, CANADA - December 30, 2004 - Angiotensin Receptor
Blockers, also called ARBs, are one of the fastest growing medications
in Canada for the treatment of high blood pressure and heart failure.
However, recent evidence published in the prestigious British Medical
Journal (November 27, 2004) raises questions about whether these drugs
can paradoxically increase the risk of having a heart attack
(myocardial infarction). In their editorial commentary entitled
"Angiotensin Receptor Blockers and Myocardial Infarction: These Drugs
May Increase Myocardial Infarction and Patients May Need to be Told",
Drs. Verma and Strauss of Toronto, reviewed the data from a number of
published trials of these drugs, as well as unpublished information
available from the FDA. The authors indicate that "unfortunately
careful evaluation of the current evidence shows that angiotensin
receptor blockers, unlike angiotensin converting enzyme inhibitors,
are either neutral or increase the rates of myocardial infarction
despite their beneficial effects on reducing blood pressure" and ask
the question whether "the time has come for clinicians, scientists,
pharmacologists, and ethicists to review the unexpected effects of
angiotensin receptor blockers on myocardial infarction and determine
whether this should be part of the discussions between doctors and
patients when starting treatment?"
The authors highlight the fact that the interpretation of large scale
clinical trials is being increasingly scrutinised, with great emphasis
being placed on the importance of sharing all potential side effects,
no matter how trivial, with patients. The authors began this
investigation after the results of the recent "VALUE" trial with
valsartan, an angiotensin receptor blocker. In this trial, high-risk
patients with high blood pressure had a 19% increase in heart attacks
compared with amlodipine another blood pressure reducing agent,
however, there was no increased rate of death. Although it remains
unclear whether this increased risk is due to a deleterious effect of
valsartan compared to a beneficial effect of amlodipine, the authors
indicate that "clinicians need to remember that treatment with
valsartan at the initial dose used in the VALUE trial (80 mg) was
associated with a significant increase in the incidence of myocardial
infarction compared with amlodipine at the initial dose of 5 mg".
Angiotensin receptor blockers have gained widespread popularity due to
their effectiveness at lowering blood pressure and improving heart
failure, with a lower incidence of "cough" which occurs with the other
class of drugs, the angiotensin converting enzyme inhibitors (ACEI).
Verma and Strauss emphasize that the "peculiar effects of ARBs on
myocardial infarction (heart attacks) stand in contrast to those of
ACEIs, which consistently produce a 20 percent or greater reduction in
myocardial infarction" highlighting that until these questions and
concerns are fully evaluated, "it may be naive to consider that ARBs
are like ACEI but without the cough"
Citation: Verma S, Strauss M. Angiotensin Receptor Blockers and
Myocardial Infarction: These drugs may increase myocardial infarction-
and patients may need to be told. BRITISH MEDICAL JOURNAL
2004;329:1248-1249 (Published November 27, 2004)
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