1. Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.

2. Background Current guidelines in hypertension and heart failure recommend ARBs in patients who are intolerant to ACE inhibitors. The average age of hypertensive patients is 65 years old and above.

3. Main objective of the study To assess the effect of ARBs on a wide range of outcomes to get a complete understanding of the benefits and harms of ARBs.

4. Methodology 16 trials with ARBs as active treatment 113 386 patients The mean age of the population in each trial had to be more than 65 years Mean follow-up: 39 months

5. Main results of the study Random effects model for the efficacy and safety outcomes in the ARB group vs the control (agent or placebo) group Outcome ARB Incidence (%) Control Incidence (%) RR95% CIP value All-cause mortality13.112.81.031.00-1.060.05 MI4.54.31.040.96-1.120.36 Stroke5.76.10.930.87-0.990.03 Heart failure hospitalization7.79.00.860.74-1.000.06 Acute kidney injury2.01.41.481.24-1.77<0.001 Hypotension5.13.71.561.24-1.97<0.001 Hyperkalemia1.61.31.571.13-2.190.008 Abbreviations: ARB, angiotensin receptor blocker; CI, confidence interval; MI, myocardial infarction; RR, risk ratio.

6. Conclusion ARBs were associated with a marginal increase in all-cause mortality when compared with an active agent. The low hazard ratio was directionally in line with the cumulative effects of hypotension, acute kidney injury, and hyperkalemia. Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.