In patients with dilated cardiomyopathy (DCM) and reduced left ventricular ejection fraction (LVEF), treatment with angiotensin II receptor blockers (ARBs) resulted in LVEF recovery more frequently than angiotensin-converting enzyme inhibitors (ACEis).

• This study included 4,618 patients with DCM with LVEF < 40%; of those, 2,238 received ACEis and 2.380 were treated with ARBs, and propensity score matching resulted in 1,341 pairs.

• The primary outcome (defined as LVEF ≥ 40% at 3 years of follow-up) occurred more frequently in ARB group vs in ACEi group (59.8% vs 54.1%; odds ratio 1.26).

• Similar results were revealed in the per-protocol analysis (62.0% vs 54.0%; odds ratio 1.39).

• Relative to baseline, a greater change in LVEF was observed at 3 years in the ARB group vs in the ACEi group (15.8 ± 0.4% vs 14.0 ± 0.4%).

• As revealed by subgroup analysis, this impact was noted independently of systolic blood pressure, heart rate, LVEF, chronic kidney disease, and concomitant use of beta-blockers and mineralocorticoid receptor antagonists.