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Updated: May 21, 2026

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
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.

Journal of Cardiovascular Pharmacology and Therapeutics
|May 20, 2026
PubMed

Insights

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.

Keywords:
ACE inhibitorHeart failure with preserved ejection fractionangiotensin receptor blockerheart failure with mildly reduced ejection fractionmortalityreal-world evidence

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