Angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers: do future research needs differ across disease states?

Matthew J Crowley,1,2 Benjamin J Powers,1,2 Evan R Myers,1,3 Douglas C McCrory,1 Amanda J McBroom,1 Gillian D Sanders11Duke Evidence-Based Practice Center, Duke Clinical Research Institute, 2Center for Health Service Research, Durham VA Medical Center, 3Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USABackground: The purpose of this study was to compare the findings of two Agency for Healthcare Research and Quality (AHRQ) future research need prioritization projects: 1) future research needs pertaining to comparative effectiveness of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin-II receptor blockers (ARB) in ischemic heart disease (IHD); and 2) future research needs pertaining to comparative effectiveness of ACE-I/ARB in hypertension.Methods: Each of the two future research need prioritization projects was based on an AHRQ-sponsored comparative effectiveness review. For each project, we worked with the authors of the corresponding comparative effectiveness review to identify evidence gaps pertaining to the comparative effectiveness of ACE-I/ARB in the target condition, and performed an update of each review's literature search strategy. We then formed a distinct stakeholder group for each future research need prioritization project and engaged each group in sequential exercises to rank the identified evidence gaps.Results: Although these projects engaged distinct stakeholder groups and relied upon different evidence bases, we noted near-complete overlap between the highest priority evidence gaps identified for each project. Stakeholders prioritized research: facilitating tailored treatment based on patient characteristics (eg, impact of demographics and comorbidities on ACE-I/ARB effectiveness); targeting optimal implementation of ACE-I/ARB among patients most likely to benefit (eg, studies to improve evidence-based use, treatment adherence, and quality of life with ACE-I/ARB); and examining the impact of ACE-I/ARB on the incidence of new cardiovascular/metabolic diagnoses.Conclusion: Designing studies to address high priority evidence gaps for multiple disease conditions simultaneously may facilitate future comparisons of ACE-I/ARB, and may likewise be an appropriate strategy to improve research efficiency in other comparative effectiveness research scenarios.Keywords: comparative effectiveness research, future research needs, hypertension, ischemic heart disease