Angiotensin converting enzyme inhibitors effect on endothelial dysfunction: A meta-analysis of randomised controlled trials

Abstract Objective Several studies have assessed the effect of angiotensin converting enzyme inhibitors (ACEIs) on endothelial dysfunction as measured by brachial flow-mediated vasodilatation (FMD). We conducted a meta-analysis to investigate this effect in comparison to placebo or no treatment and...

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Bibliographic Details
Published in:Atherosclerosis 2011-05, Vol.216 (1), p.7-16
Main Authors: Shahin, Yousef, Khan, Junaid Alam, Samuel, Nehemiah, Chetter, Ian
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - therapeutic use
Adult
Angiotensin converting enzyme inhibitors
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
antihypertensive agents
Antihypertensive Agents - therapeutic use
atherosclerosis
Atherosclerosis (general aspects, experimental research)
beta-adrenergic antagonists
Biological and medical sciences
Blood and lymphatic vessels
Blood Pressure - drug effects
Brachial Artery - drug effects
Brachial Artery - physiopathology
Brachial FMD
calcium channel blockers
Calcium Channel Blockers - therapeutic use
Cardiology. Vascular system
Cardiovascular
Cardiovascular system
Endothelial dysfunction
Endothelial function
Endothelium, Vascular - drug effects
Endothelium, Vascular - physiopathology
Evidence-Based Medicine
Female
Flow mediated dilatation
foot-and-mouth disease
Humans
Hypertension - drug therapy
Hypertension - physiopathology
Male
Medical sciences
meta-analysis
Middle Aged
patients
Pharmacology. Drug treatments
randomized clinical trials
Randomized Controlled Trials as Topic
Renin angiotensin system
Treatment Outcome
vasodilation
Vasodilation - drug effects
Vasodilator agents. Cerebral vasodilators
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Summary:Abstract Objective Several studies have assessed the effect of angiotensin converting enzyme inhibitors (ACEIs) on endothelial dysfunction as measured by brachial flow-mediated vasodilatation (FMD). We conducted a meta-analysis to investigate this effect in comparison to placebo or no treatment and to other antihypertensive agents. Methods MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1996 to October 2010 on randomised controlled trials (RCTs) that assessed the effect of ACEIs on brachial FMD versus placebo or no treatment and ACEIs versus angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and β-blockers. Data from included studies were pooled with use of random effects meta-analysis of the weighted mean change differences between the comparator groups. Heterogeneity across studies was assessed with the I2 statistic. Results In 10 trials including 1129 patients, treatment with ACEIs ( n = 498) versus placebo or no treatment ( n = 503) significantly improved brachial FMD (pooled mean change difference 1.26%, 95% C.I. 0.46–2.07, p = 0.002 with significant heterogeneity). In 11 trials which included 805 patients, treatment with ACEIs ( n = 264) had a significant effect on brachial FMD when compared with other antihypertensives (ARBs, CCBs and β-blockers) ( n = 420) (pooled mean change difference 0.89%, 95% C.I. 0.22–1.56, p = 0.009, I2 = 83%, p for heterogeneity < 0.00001). In 7 trials, treatment with ACEIs had no significant effect on FMD when compared with ARBs (pooled mean change difference = 0.21%, 95% C.I. −0.24 to 0.66, p = 0.36, I2 = 0%). However, in 4 trials ACEIs significantly improved FMD when compared with CCBs (pooled mean change difference 2.15%, 95% C.I. 0.55–3.75, p = 0.009, I2 = 90%, p for heterogeneity < 0.00001). When compared with β-blockers in 4 trials, ACEIs also had a significant effect on FMD (pooled mean change difference = 0.59%, 95% C.I. 0.05–1.13, p = 0.03, I2 = 34%, p for heterogeneity = 0.21). Conclusions This study shows that ACEIs improve brachial FMD which is a marker of endothelial function in patients with endothelial dysfunction caused by various conditions and are superior to CCBs and β-blockers. There was no significant difference between ACEIs and ARBs effect on brachial FMD.
ISSN:0021-9150
1879-1484
DOI:10.1016/j.atherosclerosis.2011.02.044