Related Experiment Video
Updated: May 21, 2026
08:35
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Comparative Effectiveness of Renin-Angiotensin System Inhibitors in Heart Failure With Nonreduced Ejection Fraction:
Ming-Shyan Lin1,2,3, Po-Chang Wang1, Jung-Jung Chang1
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.
Summary
Angiotensin receptor blockers (ARBs) showed lower all-cause mortality than angiotensin-converting enzyme inhibitors (ACEis) in heart failure with nonreduced ejection fraction (HFnon-rEF). Cardiovascular outcomes were similar between these drug classes in this real-world study.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Uncertainty exists regarding the comparative effectiveness of ACEis and ARBs for HFnon-rEF.
- Real-world data on long-term outcomes for these therapies post-acute heart failure hospitalization are limited.
Purpose of the Study:
- To compare long-term cardiovascular outcomes and mortality between ACEis and ARBs in patients with HFnon-rEF.
- To evaluate the effectiveness of non-renin-angiotensin system inhibitors (RASi) as a comparator group.
Main Methods:
- Retrospective multicenter study of 5837 patients with HFnon-rEF (LVEF ≥ 40%) from 2005-2019.
- Patients were grouped by discharge prescription: ACEi, ARB, or non-RASi.
- Used a 14-day landmark approach and inverse probability of treatment weighting to minimize bias and balance covariates.
Main Results:
- The primary composite outcome of CV death or HF rehospitalization at 1 year was similar between ARB and ACEi users (aHR, 0.94; 95% CI, 0.75-1.17).
- ARB therapy was associated with significantly lower all-cause mortality compared to ACEi (aHR, 0.74; 95% CI, 0.55-0.99) and non-RASi (aHR, 0.80; 95% CI, 0.67-0.94).
Conclusions:
- In real-world HFnon-rEF patients, ARB use was linked to reduced all-cause mortality versus ACEi, with similar CV event rates.
- These findings are hypothesis-generating and do not establish ARB superiority; further research is warranted.
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