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Effective Health Care Program

Future Research Needs for Angiotensin Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease

Systematic Review

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This report is from AHRQ's series on Future Research Needs Projects.


A comparative effectiveness review (CER) published by the University of Connecticut Evidence-based Practice Center (EPC) in 2009 found strong evidence that ACE inhibitors reduced total mortality and nonfatal myocardial infarction (MI) in comparison to placebo among adults with stable IHD and preserved ventricular function, but increased the risk for syncope and cough. There was low to moderate evidence that ARBs reduced a composite of cardiovascular endpoints compared to placebo, and these agents were well-tolerated. The one available study directly comparing the impact of ACE inhibitors and ARBs on cardiovascular outcomes in patients with IHD revealed no significant difference between the classes in the rate of cardiovascular outcomes, but demonstrated higher rates of cough and angioedema among patients treated with ACE inhibitors, and higher rates of hypotensive symptoms among patients treated with ARBs.

A list of research gaps is a common component of CERs and is an important step in outlining a future research agenda; however, such lists do not always clearly suggest how future research should be prioritized, or which projects are in fact feasible. In this pilot project, we sought to expand on the work done by the University of Connecticut EPC to identify and prioritize gaps in the evidence supporting the comparative effectiveness of ACE inhibitor and ARB therapy in patients with IHD. The prioritization process we used combined a review of recently published and ongoing studies, engagement of nine stakeholders, and participation of these stakeholders in both qualitative and quantitative exercises of research needs prioritization.