Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

ACEI and ARB in HF increases adverse effects

A meta analysis published in the Archives of Internal Medicines has examined the safety of prescribing combinations of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in patients with heart failure.

A search strategy revealed four randomised studies involving 17,337 patients that met the pre-defined inclusion criteria. The data were analysed for adverse events including symptomatic hypotension, worsening renal function, hyperkalaemia and treatment discontinuation.

The risk of:

  • Treatment discontinuation was 28% higher [95% CI 1.17-1.40] in the combination cohort
  • Symptomatic hypotension was 48% higher [95% CI 1.34-1.62] in the combination cohort
  • Worsening renal function was 76% higher [95% CI 1.49-2.09] in the combination cohort
  • Hyperkalaemia was 246% higher [95% CI 0.68-8.87 Not Significant] in the combination cohort

The authors conclude that, "Combination ARB plus ACE inhibitor therapy was accompanied by marked increases in adverse effects". It is also stated that these results are consistent with HF Guidelines that have expressed reservations about the place in therapy for the combination.

Action: Clinicians should ensure that single agents are used and titrated to maximum tolerated doses before considering combination treatment. It may be appropriate to seek specialist advice before starting combination therapy.

Share 'ACEI and ARB in HF increases adverse effects' on Email Share 'ACEI and ARB in HF increases adverse effects' on Delicious Share 'ACEI and ARB in HF increases adverse effects' on Digg Share 'ACEI and ARB in HF increases adverse effects' on Facebook Share 'ACEI and ARB in HF increases adverse effects' on Google+ Share 'ACEI and ARB in HF increases adverse effects' on reddit Share 'ACEI and ARB in HF increases adverse effects' on StumbleUpon Share 'ACEI and ARB in HF increases adverse effects' on Twitter

atomic-wealth

No Comments to “ACEI and ARB in HF increases adverse effects”

Leave a Comment

(required)

(required)


Prescribing Advice for GPs is powered by WordPress.
Subscribe for Free to our RSS or Atom Feeds for New Entries.
Akismet has protected Prescribing Advice for GPs from 789,615 spam comments.

atomic-wealth
fond-illness
summer