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Renin-angiotensin-aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular
Wuxiang Xie1, Fanfan Zheng2, Xiaoyu Song3
1Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
International Journal of Cardiology
|January 1, 2016
Summary
Angiotensin receptor-neprilysin inhibitors (ARNI) are most effective for reducing mortality and hospitalizations in heart failure with reduced ejection fraction (HFrEF). Aldosterone receptor antagonists (ARA) offer a favorable benefit-risk profile when added to existing therapies.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Renin-angiotensin-aldosterone system (RAAS) blockers are established treatments for heart failure with reduced ejection fraction (HFrEF) and left ventricular dysfunction (LVD).
- Assessing the comparative efficacy and safety of different RAAS blockers is crucial for optimizing patient care.
Purpose of the Study:
- To conduct a network meta-analysis evaluating the efficacy and safety of various RAAS blockers in patients with HFrEF or LVD.
- To identify the most effective RAAS-based therapies for reducing mortality and heart failure hospitalizations.
Main Methods:
- Systematic search of major medical databases (MEDLINE, EMBASE, Cochrane Library) up to May 2015.
- Inclusion of 21 double-blind randomized controlled trials (RCTs) involving 69,229 patients.
- Network meta-analysis to compare multiple RAAS blockers against placebo and each other.
Main Results:
- Angiotensin receptor-neprilysin inhibitors (ARNI) demonstrated the highest probability of reducing all-cause mortality (OR=0.67) and heart failure hospitalizations (OR=0.55).
- Aldosterone receptor antagonists (ARA), when added to ACEI/ARB therapy, significantly reduced mortality (OR=0.73) and hospitalization risk (OR=0.67) without substantially increasing discontinuation.
- Combination therapy with ARB plus ACEI also showed significant benefit in preventing hospitalizations (OR=0.61).
Conclusions:
- ARNI represents the most efficacious therapy for HFrEF, offering the greatest reduction in death and heart failure hospitalizations.
- ARA is a valuable adjunct to existing ACEI/ARB therapy, providing a favorable benefit-risk profile for HFrEF patients.
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