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European Journal of Heart Failure 2007 9(6-7):602-609; doi:10.1016/j.ejheart.2007.02.001
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© 2007 European Society of Cardiology

Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure — A population study

Marie Hudsona,*,1, Elham Rahmea, Hassan Behloulia, Richard Sheppardb and Louise Pilotea,1

a Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, 1650 Cedar Ave, Montreal (QC), Canada H3G 1A4
b Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada

* Corresponding author. Tel: +1 514 934 1934x44163; fax: +1 514 934 8293. E-mail address: marie.hudson{at}mcgill.ca


  Abstract

Background: Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to improve survival in patients with congestive heart failure (CHF). We wish to determine whether there are sex-related differences in the optimal treatment of congestive heart failure.

Methods: Using administrative databases, all patients > >=65 years of age discharged with a diagnosis of CHF between January 1998 and March 2003 and who filled a prescription for an ARB or an ACE inhibitor within 90 days of discharge were identified. Time to all-cause death in women and men on ACE inhibitors or ARBs was compared.

Results: There were 10,223 women (8627 ACE inhibitors and 1596 ARBs) and 9475 men (8484 ACE inhibitors and 991 ARBs). Hypertension was more common in women (50.1%) than men (33.1%). Women on ARBs had better survival than those on ACE inhibitors (adjusted hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.59, 0.80). There was no difference in survival in men prescribed ARBs compared to ACE inhibitors (HR 1.10, 95% CI 0.95, 1.30).

Conclusion: These sex differences in treatment-related outcome are important but should be confirmed in a randomized trial before ARBs are preferentially prescribed to women with CHF.

Key Words: Angiotensin receptor blockers • Angiotensin converting enzyme inhibitors • Congestive heart failure • Sex differences

Received March 20, 2006; Revised November 27, 2006; Accepted February 5, 2007

{star} This study was undertaken as part of the Gender and Sex Determinants of Cardiovascular Disease (GENESIS) project, funded by the Canadian Institutes of Health Research, grant # 72565, and the Heart and Stroke Foundation of Canada.

1 Drs Hudson and Pilote are funded by the Canadian Institutes of Health Research. Dr Pilote is a William Dawson Professor of Medicine at McGill University.


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