Review: Angiotensin II receptor blocker plus angiotensin-converting enzyme inhibitor increases risk for adverse effects.

M e t h o d s Data sources: MEDLINE and EMBASE/ Excerpta Medica (to December 2006), Cochrane Library, National Institutes of Health Clinical Trials and US Food and Drug Administration Web sites, and reference lists. Study selection and assessment: Randomized controlled trials (RCTs) with ≥ 500 patients that compared the combination of ARB and ACE-I with standard therapy that included ACE-I for LV dysfunction, had ≥ 3 months of follow-up, and reported adverse effects. 4 RCTs met the selection criteria: 3 RCTs (n = 7633, mean age 63 y, 82% men) of patients with chronic heart failure (CHF) and 1 RCT (n = 9794, mean age 65 y, 69% men) of patients with acute myocardial infarction (AMI) and symptomatic LV dysfunction. Mean duration of follow-up was 25 months. Quality assessment of individual trials was done using the 5-point Jadad scale. Study quality was high (median Jadad score 4). Outcomes: Medication discontinuation because of adverse effects, worsening renal function (increase in serum creatinine level > 0.5 mg/dL [44 μmol/L]), hyperkalemia (serum potassium level >5.5 mEq/L [5.5 mmol/L]), and symptomatic hypotension.