Adding ACE inhibitors or ARBs to standard therapy for stable ischemic heart disease.

Evidence-Based Answer Adding an ACE inhibitor to standard therapy reduces total mortality and cardiovascular events. Adding an ARB also reduces cardiovascular events. Overall effects are modest. Current evidence does not support the use of ACE inhibitor and ARB combinations over ACE inhibitors alone, because the risk of adverse events increases without additional benefit. Evidence suggests that adding ACE inhibitors or ARBs close to revascularization increases the risk of subsequent revascularization and hypotension. There were insufficient data to determine differences in effectiveness among specific ACE inhibitors and ARBs. (Strength of Recommendation: A, based on consistent, good-quality patientoriented evidence.)