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

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) management remains challenging.
• Previous studies on ACE-Is and ARBs in HFpEF have produced conflicting results.
• A comprehensive analysis of existing evidence is necessary to clarify the role of these drug classes.

Purpose of the Study:

• To systematically review and meta-analyze all available evidence on ACE-Is and ARBs in HFpEF patients.
• To evaluate the impact of ACE-Is and ARBs on all-cause mortality and cardiovascular outcomes.
• To assess the effect on heart failure hospitalization risk.

Main Methods:

• Systematic search of major databases (PubMed, Ovid SP, Embase, Cochrane).
• Inclusion of randomized trials and observational studies comparing ACE-I or ARBs against placebo or standard therapy.
• Random-effects models used for data pooling and I² testing for heterogeneity assessment.

Main Results:

• Pooled analysis of 6 randomized trials showed no significant effect of ACE-Is and ARBs on all-cause mortality (RR=1.02, 95% CI=0.93-1.11).
• Observational studies indicated a significant improvement in all-cause mortality (RR=0.91, 95% CI=0.87-0.95).
• Pooled analysis of all studies revealed a reduction in all-cause mortality with ACE-Is (RR=0.91, 95% CI=0.87-0.95); no significant reduction in cardiovascular mortality was observed, but a trend towards reduced HF hospitalizations was noted in randomized trials (RR=0.91, 95% CI=0.83-1.01).

Conclusions:

• ACE-Is and ARBs may offer benefits in improving outcomes for HFpEF patients, particularly regarding all-cause mortality.
• The discrepancy between randomized trials and observational studies highlights the need for careful patient selection.
• Future research with refined trial designs is crucial to definitively establish the role of ACE-Is and ARBs in HFpEF management.