BMJ  2005;330:1270 (28 May), doi:10.1136/bmj.330.7502.1270

Letter

Angiotensin receptor blockers and myocardial infarction

Direct comparative studies are needed

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

Editor—The editorial by Verma and Strauss does not accord with the BMJ's usual impartial evidence based approach.¹ Evidence that angiotensin receptor blockers increase myocardial infarction is scant, and I remain puzzled about what exactly patients should be told—that the BMJ published an incorrect analysis?

Regarding angiotensin receptor blockers and myocardial infarction in hypertension, the data from the valsartan antihypertensive long term use evaluation (VALUE) trial, quoted by Verma and Strauss, can be added to a prior meta-analysis by the Blood Pressure Trialists.² The incidence of coronary heart disease and myocardial infarction is 804/16061 (5%) in the treated groups and 763/15948 (4.78%) in the controls (odds ratio 1.046), a non-significant increase of myocardial infarction of 4.6% v controls, whereas lisinopril increased combined cardiovascular disease by 10%.³

Regarding candesartan and heart failure, in the predefined group of patients with low left ventricular ejection fractions (< 40%), candesartan reduced all cause mortality . . . [Full text of this article]

¹ Hatter Institute, University of Cape Town, Medical School, Observatory, Cape Town, South Africa opie@capeheart.uct.ac.za

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