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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Do ARBs increase MI risk?

In 2004, an editorial in the British Medical Journal raised a concern that Angiotensin II Receptor Blockers (ARBs) may increase the risk of myocardial infarction.

Since this article several reviews have been published that have dismissed the link however two new articles [subscription required] published in Circulation may revive the debate.

In both articles the authors have conducted reviews of available evidence using different inclusion criteria. One article concludes that MI event risk is increased in ARB users, the other finds no difference between ARB users and control subjects.

The common ground shared by the two papers is that Angiotensin Converting Enzyme Inhibitors (ACEIs) are superior to ARBs. Furthermore, neither paper demonstrated that ARBs actually reduce MI risk; ARBs may not be "ACEIs without a cough".

Action: ACEIs remain the first line drug choice in this class of medicines. ARBs should only be used when ACEIs are not tolerated and in these cases patients should be informed of the differences in MI risk.

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