The “ARB-MI Paradox”: Real or a Fluke?

[...]the doxazosin (Cardura) arm was stopped early because doxazosin was less cardioprotective.4 Andrea: Even though we measure it and swear by it as an end point, blood pressure is only a surrogate outcome. At best, ARBs have a modest effect on the risk of diabetes, congestive heart failure, and stroke (less than a 10 percent relative risk reduction). * Blood pressure, like many other measurements such as A1C, is a surrogate end point and does not necessarily reflect what is happening to the patient-the patient may not benefit even if his or her blood pressure is lowered. * As always, look for patient-oriented outcomes that we care about, such as stroke, MI, and death. EBM Points * A good meta-analysis requires the following (among other things): A sensitivity analysis: exclude outliers, such as large, heavily weighted studies and studies of marginal quality, to check whether the results are the same * An extensive literature search, including a search for unpublished material (such as from drug companies) * An analysis of the quality of studies included in the meta-analysis (one set of criteria is published by The Cochrane Collaboration) * More than one person extracting the data from each study (do the reviewers agree on something as basic as the data to be analyzed?) Address correspondence to Mark A. Graber, MD, FACEP, at markagraber@gmail.com.