Letters |

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

Lars H. Lund, MD, PhD; Lina Benson, MSc
JAMA. 2013;309(11):1107-1108. doi:10.1001/jama.2013.1975.
Text Size: A A A
Published online


In Reply: The efficacy of RAS antagonists in HFPEF remains controversial. Our study should be interpreted in light of other evidence and within the methodological constraints of nonrandomized studies. In the article, we discussed at length the randomized controlled trials and meta-analyses that have been published on the topic, which both support and contrast with our findings, and limitations of our study.

Drs Fonarow and Ahmed call particular attention to 2 negative studies. The study by Patel et al1 assessed angiotensin II receptor blockers and not ACE inhibitors. It had only 296 patient pairs (compared with 3329 in our study) and the point estimate for the hazard ratio for all-cause mortality (0.93) was similar to ours (0.91), but their low power yielded a nonsignificant 95% CI (0.76-1.14) compared with ours (0.85-0.98). Furthermore, that study did not adjust for fundamental clinical and socioeconomic confounders such as treatment dose, New York Heart Association class, marital and living arrangements, and follow-up care. In addition, in our study, 75% of RAS antagonist treatment was ACE inhibitors, which may be more effective than angiotensin II receptor blockers.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




March 20, 2013
Gregg C. Fonarow, MD; Ali Ahmed, MD
JAMA. 2013;309(11):1107-1108. doi:10.1001/jama.2013.1969.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...