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Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis.

Publication ,  Journal Article
Khan, MS; Fonarow, GC; Khan, H; Greene, SJ; Anker, SD; Gheorghiade, M; Butler, J
Published in: ESC Heart Fail
November 2017

Studies with angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in patients with heart failure with preserved ejection fraction (HFpEF) have yielded inconsistent results. To conduct a systematic review and meta-analysis of all evidence for ACE-I and ARBs in patients with HFpEF, we searched PubMed, Ovid SP, Embase, and Cochrane database to identify randomized trials and observational studies that compared ACE-I or ARBs against placebo or standard therapy in HFpEF patients. Random-effect models were used to pool the data, and I2 testing was performed to assess the heterogeneity of the included studies. A total of 13 studies (treatment arm = 8676 and control arm = 8608) were analysed. Pooled analysis of randomized trials for ACE-I and ARBs (n = 6) did not show any effect on all-cause mortality [relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.93-1.11, P = 0.68, I2  = 0%], while results from observational studies showed a significant improvement (RR = 0.91, 95% CI = 0.87-0.95, P = 0.005, I2  = 81.5%). In pooled analyses of all studies, ACE-I showed a reduction of all-cause mortality (RR = 0.91, 95% CI = 0.87-0.95, P = 0.01). There was no reduction in cardiovascular mortality seen, but in pooled analysis of randomized trials, there was a trend towards reduced HF hospitalization risk (RR = 0.91, 95% CI = 0.83-1.01, I2  = 0%, P = 0.074). These data suggest that ACE-I and ARBs may have a role in improving outcomes of patients with HFpEF, underscoring the need for future research with careful patient selection, and trial design and conduct.

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Published In

ESC Heart Fail

DOI

EISSN

2055-5822

Publication Date

November 2017

Volume

4

Issue

4

Start / End Page

402 / 408

Location

England

Related Subject Headings

  • Stroke Volume
  • Renin-Angiotensin System
  • Humans
  • Heart Failure
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin Receptor Antagonists
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Khan, M. S., Fonarow, G. C., Khan, H., Greene, S. J., Anker, S. D., Gheorghiade, M., & Butler, J. (2017). Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail, 4(4), 402–408. https://doi.org/10.1002/ehf2.12204
Khan, Muhammad Shahzeb, Gregg C. Fonarow, Hassan Khan, Stephen J. Greene, Stefan D. Anker, Mihai Gheorghiade, and Javed Butler. “Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis.ESC Heart Fail 4, no. 4 (November 2017): 402–8. https://doi.org/10.1002/ehf2.12204.
Khan MS, Fonarow GC, Khan H, Greene SJ, Anker SD, Gheorghiade M, et al. Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail. 2017 Nov;4(4):402–8.
Khan, Muhammad Shahzeb, et al. “Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis.ESC Heart Fail, vol. 4, no. 4, Nov. 2017, pp. 402–08. Pubmed, doi:10.1002/ehf2.12204.
Khan MS, Fonarow GC, Khan H, Greene SJ, Anker SD, Gheorghiade M, Butler J. Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail. 2017 Nov;4(4):402–408.
Journal cover image

Published In

ESC Heart Fail

DOI

EISSN

2055-5822

Publication Date

November 2017

Volume

4

Issue

4

Start / End Page

402 / 408

Location

England

Related Subject Headings

  • Stroke Volume
  • Renin-Angiotensin System
  • Humans
  • Heart Failure
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin Receptor Antagonists
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology