BMJ  2005;330:1269 (28 May), doi:10.1136/bmj.330.7502.1269

Letter

Angiotensin receptor blockers and myocardial infarction

Analysis of evidence is incomplete and inaccurate

The first 150 words of the full text of this article appear below.

Editor—Verma and Strauss say that, compared with angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers do not reduce (and may increase) the risk of myocardial infarction.1 Their claim represents an incomplete, inaccurate, and misleading "analysis" of the evidence.

They did not cite the two largest studies that randomised patients to an ACE inhibitor or angiotensin receptor blockers and had the statistical power to evaluate cardiovascular outcomes.2 3 These had twice as many myocardial infarctions as their trials combined (table). As none of their trials randomised these two treatments, their conclusions depend on indirect comparisons, small numbers of events and are unreliable. OPTIMAAL (379 patients with MI in the captopril group and 384 losartan) and VALIANT (798 total myocardial infarctions in captopril group, 796 valsartan) strongly refute the authors' hypothesis.

Other data were selectively and incorrectly cited—for example, mentioning the only CHARM trial with an excess of myocardial infarctions in the candesartan . . . [Full text of this article]

John McMurray, professor of medical cardiology1

1 Department of Cardiology, Western Infirmary, Glasgow G11 6NT j.mcmurray@bio.gla.ac.uk


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Relevant Article

Angiotensin receptor blockers and myocardial infarction
Subodh Verma and Marty Strauss
BMJ 2004 329: 1248-1249. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

  • Strauss, M. H., Hall, A. S. (2006). Angiotensin Receptor Blockers May Increase Risk of Myocardial Infarction: Unraveling the ARB-MI Paradox. Circulation 114: 838-854 [Full text]  
  • Tsuyuki, R. T., McDonald, M. A. (2006). Response to Tsuyuki and McDonald. Circulation 114: 855-860 [Full text]  
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