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High ACEI, ARB doses decrease mortality rates in HF patients

31 Aug 2017

Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), delivered in high doses, improve composite all-cause mortality and hospitalization outcomes in heart failure patients with reduced ejection fraction, according to a new meta-analysis.

Pooled analysis of all six included randomized trials (five with ACEI, one with ARB; n=9,171; mean age 62.8 years) showed that those who received high doses of either ACEI or ARB (n=4,330) had lower all-cause mortality (relative risk [RR], 0.94; 95 percent CI, 0.89 to 1.00; p=0.05) than those who received low doses (n=4,841).

Cardiovascular mortality, investigated in four trials, was also significantly lower in patients who received high doses (RR, 0.93; 0.87 to 0.99; p=0.03).

On the other hand, limiting the meta-analysis to ACEI only yielded no significant reductions in all-cause mortality (RR, 0.95; 0.87 to 1.02; p=0.15).

Pooled data from three trials showed that the risk of the composite endpoint of all-cause mortality and HF-related hospitalization was significantly lower in the high-dose group than in the low-dose group (RR, 0.93; 0.87 to 0.99; p=0.04).

In contrast, all-cause hospitalization (RR, 0.97; 0.85 to 1.11; p=0.67), reported in four trials, and HF-related admissions (RR, 0.94; 0.70 to 1.26; p=0.68) were not significantly different between high- and low-dose groups.

In terms of safety, there was no significant difference in the chance of treatment discontinuation because of adverse events between high- and low-dose groups (odds ratio [OR], 1.12; 0.92 to 1.39; p=0.25).

There were no differences in terms of hypotension (OR, 1.27; 0.81 to 2.01; p=0.30) and renal failure (OR, 1.32; 0.97 to 1.78; p=0.10). However, high ACEI or ARB dose was associated with higher chances of hyperkalaemia (OR, 2.07; 1.20 to 3.59; p=0.01).

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Most Read Articles
Elvira Manzano, 6 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
Yesterday
Drinking coffee, whether caffeinated or decaffeinated, is associated with a reduced risk of cardiovascular disease (CVD) and ischaemic heart disease (IHD) mortality in patients with a prior myocardial infarction (MI), according to a recent study.
3 days ago
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.