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Prognostic and Safety Implications of Renin-Angiotensin-Aldosterone System Inhibitors in Hypertrophic Cardiomyopathy:

Chan Soon Park1, Tae-Min Rhee1, Hyun Jung Lee1,2

  • 1Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.

Korean Circulation Journal
|September 1, 2023
PubMed

Insights

Renin-angiotensin-aldosterone system inhibitors (RASi) did not worsen outcomes in hypertrophic cardiomyopathy (HCM) patients. This study suggests RASi can be safely used in HCM patients when clinically indicated.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • Renin-angiotensin-aldosterone system inhibitors (RASi) use in hypertrophic cardiomyopathy (HCM) is debated due to concerns about worsening left ventricular outflow tract (LVOT) obstruction.
  • The prognostic and safety implications of RASi in HCM remain incompletely understood.

Purpose of the Study:

  • To investigate the safety and prognostic implications of RASi in a large cohort of patients diagnosed with HCM.
  • To evaluate the association between RASi use and clinical outcomes, including all-cause mortality and heart failure hospitalizations.

Main Methods:

  • A total of 2,104 patients with HCM were enrolled from two tertiary university hospitals and followed for five years.
  • RASi use was defined as administration after HCM diagnosis. Primary outcomes were all-cause mortality and hospitalization for heart failure (HHF).
  • Multivariable and subgroup analyses were performed to assess the impact of RASi on outcomes, considering factors like LVOT obstruction and LV ejection fraction.

Main Results:

  • RASi were prescribed to 36.2% of patients. Over a median follow-up of 48.1 months, 5.3% died and 4.5% were hospitalized for heart failure.
  • Despite baseline differences, RASi use was not associated with significantly different rates of all-cause mortality or HHF compared to non-RASi users.
  • Subgroup analyses showed no significant interaction between RASi use and LVOT obstruction, LV ejection fraction, or LV wall thickness.

Conclusions:

  • RASi use was not associated with adverse clinical outcomes in patients with hypertrophic cardiomyopathy.
  • RASi may be safely administered to HCM patients when clinically indicated, challenging previous concerns about LVOT obstruction aggravation.
Abstract

Keywords:
Hypertrophic cardiomyopathyMortalityPrognosisRenin-angiotensin system

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