The Effect of Renin-Angiotensin System Inhibitors on Mortality and Heart Failure Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction: A Systematic Review and Meta-Analysis |
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| Authors: | Ravi V. Shah Akshay S. Desai Michael M. Givertz |
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| Affiliation: | 1. University of California, San Francisco, CA, United States;2. University of California, Los Angeles, CA, United States;3. Meharry Medical College, Nashville, TN, United States;4. University of Alabama at Birmingham, Birmingham, AL, United States;5. Case Western Reserve University, Cleveland, OH, United States;6. Wake Forest School of Medicine, Winston-Salem, NC, United States;7. Northwestern University, Chicago, IL, United States;8. Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, United States;9. Veterans Affairs Medical Center, Birmingham, AL, United States;1. Clinical Trial Center, Dong-A University Hospital, Busan, South Korea;2. Department of Cardiology, Dong-A University Hospital, Busan, South Korea;3. HeartDrug? Research Laboratories, Johns Hopkins University, Baltimore, MD, USA |
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| Abstract: | ![]()
BackgroundAlthough renin-angiotensin system (RAS) inhibitors have little demonstrable effect on mortality in patients with heart failure and preserved ejection fraction (HF-PEF), some trials have suggested a benefit with regard to reduction in HF hospitalization.Methods and ResultsHere, we systematically review and evaluate prospective clinical studies of RAS inhibitors enrolling patients with HF-PEF, including the 3 major trials of RAS inhibition (Candesartan in Patients with Chronic Heart Failure and Preserved Left Ventricular Ejection Fraction [CHARM-Preserved], Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction [I-PRESERVE], and Perindopril in Elderly People with Chronic Heart Failure [PEP-CHF]). We also conducted a pooled analysis of 8021 patients in the 3 major randomized trials of RAS inhibition in HF-PEF (CHARM-Preserved, I-PRESERVE, and PEP-CHF) in fixed-effect models, finding no clear benefit with regard to all-cause mortality (odds ratio [OR] 1.03, 95% confidence interval [CI], 0.92-1.15; P = .62), or HF hospitalization (OR 0.90, 95% CI 0.80-1.02; P = .09).ConclusionsAlthough RAS inhibition may be valuable in the management of comorbidities related to HF-PEF, RAS inhibition in HF-PEF is not associated with consistent reduction in HF hospitalization or mortality in this emerging cohort. |
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