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Relative efficacy of angiotensin converting enzyme inhibitors on mortality of patients with congestive heart failure:
P Nony1, J P Boissel, P Girard
1Unité de Pharmacologie Clinique, Hôpital Cardiovasculaire et Pneumologique, Lyon, France.
European Heart Journal
|August 1, 1992
Summary
Angiotensin converting enzyme (ACE) inhibitors significantly reduced mortality in patients with ischaemic heart failure. Further trials are needed to confirm benefits in non-ischaemic heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Heart failure (HF) is a major cause of morbidity and mortality.
- Angiotensin converting enzyme (ACE) inhibitors are a cornerstone therapy for HF.
- The differential effect of ACE inhibitors on HF outcomes based on aetiology is not fully elucidated.
Purpose of the Study:
- To evaluate the impact of ACE inhibitors on mortality in patients with heart failure.
- To compare the efficacy of ACE inhibitors in ischaemic versus non-ischaemic heart failure.
Main Methods:
- Systematic review and meta-analysis of 11 randomized, placebo-controlled trials.
- Inclusion of 1266 patients with heart failure of ischaemic or non-ischaemic origin.
- Follow-up periods ranged from 3 to 6 months.
Main Results:
- Mortality was significantly reduced in the ischaemic heart failure subgroup (OR 0.45; 95% CI 0.28–0.71).
- A trend towards mortality reduction was observed in the non-ischaemic subgroup, but it was not statistically significant (OR 0.7; 95% CI 0.4–1.5).
- No significant difference in the odds ratio between the two subgroups.
Conclusions:
- ACE inhibitors demonstrate a significant mortality benefit in patients with ischaemic heart failure.
- Further large-scale, randomized, placebo-controlled trials are warranted to precisely determine the benefit-risk ratio of ACE inhibitors in non-ischaemic heart failure.
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