[Skip to Content]
[Skip to Content Landing]
Views 808
Citations 0
March 20, 2013

Renin-Angiotensin System Antagonists and Mortality in Patients With Heart Failure

JAMA. 2013;309(11):1107-1108. doi:10.1001/jama.2013.1969

To the Editor: In a propensity-matched cohort of patients with heart failure with preserved ejection fraction (HFPEF), Dr Lund and colleagues reported that the use of renin-angiotensin system (RAS) antagonists (angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers) was associated with lower all-cause mortality.1 Yet multiple prospective randomized placebo-controlled trials have demonstrated no efficacy for mortality with these medications in patients with HFPEF, and a meta-analysis including all randomized controlled trials published to date also found no mortality benefit (hazard ratio, 1.02; 95% CI, 0.94-1.12; P = .60).2 Can there be effectiveness of drugs in clinical practice in the absence of demonstrated efficacy for the same disease state in randomized controlled trials?

First Page Preview View Large
First page PDF preview
First page PDF preview