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The Effect of Angiotensin II Receptor Blockers in Patients with Hypertrophic Cardiomyopathy: An Updated Systematic
Basel Abdelazeem1,2, Kirellos Said Abbas3, Soban Ahmad4
1Internal Medicine, McLaren Health Care, Flint, MI 48532, USA.
Insights
Angiotensin receptor blocker (ARB) therapy significantly reduces left ventricular mass and systolic blood pressure in hypertrophic cardiomyopathy (HCM) patients. Further research is recommended to confirm these findings in larger populations.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a condition where disease progression can potentially be slowed by Angiotensin receptor blocker (ARB) therapy.
- Limited evidence currently exists regarding the efficacy of ARB therapy in modifying HCM progression.
Purpose of the Study:
- To conduct a meta-analysis evaluating the effectiveness of Angiotensin receptor blocker (ARB) therapy as a disease-modifying treatment for patients diagnosed with hypertrophic cardiomyopathy (HCM).
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, Scopus, Web of Science, Embase, Cochrane library, Clinicaltrials.gov) up to December 13th, 2021.
- Only randomized controlled trials (RCTs) were included, with study quality assessed using the Cochrane Collaboration's tool.
- Primary outcomes focused on left ventricular mass reduction and echocardiographic improvements in myocardial dysfunction, while the secondary outcome was systolic blood pressure reduction. Meta-analysis used standardized mean difference (SMD) and 95% confidence intervals (CI).
Main Results:
- Seven RCTs involving 397 HCM patients (195 in the ARB group) met the inclusion criteria.
- Angiotensin receptor blocker (ARB) treatment demonstrated a significant reduction in left ventricular mass (SMD: -0.77; 95% CI: -1.40, -0.03; p = 0.04).
- A significant decrease in systolic blood pressure was also observed with ARB therapy (SMD: -0.33; 95% CI: -0.61, -0.05; p = 0.02).
Conclusions:
- Angiotensin receptor blocker (ARB) therapy is linked to a notable reduction in both left ventricular mass and systolic blood pressure in individuals with hypertrophic cardiomyopathy (HCM).
- The findings suggest ARB therapy may be a beneficial treatment option for managing HCM.
- Further large-scale studies are recommended to validate these meta-analysis results and solidify the role of ARBs in HCM management.
Background:
Angiotensin receptor blocker (ARB) therapy has been evaluated to slow down the disease progression in patients with hypertrophic cardiomyopathy (HCM), but there is scarce evidence available to date. Therefore, our meta-analysis aimed to explore the efficacy of ARB therapy as a potential disease-modifying treatment in patients with HCM.
Methods:
A literature search was performed using PubMed, Scopus, Web of Science, Embase, Cochrane library, and Clinicaltrials.gov databases from inception to December 13th, 2021. We included only randomized controlled trials (RCTs). The quality of included studies was assessed by the Cochrane Collaboration's tool. Primary outcomes included the reduction in left ventricular mass and improvement in other echocardiographic features of myocardial dysfunction. The secondary outcome was a net reduction in systolic blood pressure. Meta-analysis was performed using pooled standardized mean difference (SMD) and corresponding 95% confidence interval (CI).
Results:
A total of 1286 articles were screened. Seven RCTs met the inclusion criteria representing a total of 397 patients with HCM (195 patients were in the ARB group). ARB treatment was associated with significant reduction in left ventricular mass (SMD: -0.77; 95% CI: -1.40, -0.03; p = 0.04). ARB therapy was also associated with a significant reduction in systolic blood pressure (SMD: -0.33; 95% CI: -0.61, -0.05: p = 0.02).
Conclusions:
ARB therapy is associated with a marked reduction in left ventricular mass and systolic blood pressure in patients with hypertrophic cardiomyopathy. We recommend further studies with a larger patient population size to confirm the findings of our meta-analysis.
Clinical Trial Registration:
OSF Registries, DOI: 10.17605/OSF.IO/DAS7C.
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