High ACEI, ARB doses decrease mortality rates in HF patients
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).