Can Angiotensin Receptor Blockers (ARBS) Increase Heart Attacks? New Information From The British Medical Journal
TORONTO, ONTARIO, CANADA (PRWEB) January 19, 2005
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 Verma and Strauss of Toronto, reviewed the data from a number of published trials of these drugs, as well as unpublished information available from the FDA.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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