Most Read Articles
Roshini Claire Anthony, 23 Nov 2017

The long-term mortality benefit conferred by mechanical over biologic prosthesis in valve replacement appears to be age- and location-dependent, according to findings of a US-based retrospective study.  

10 Jan 2018
Shared decision support with the use of standardized decision aids improves decision quality and reduces implantation of left ventricular assist device as destination therapy (DT-LVAD) in patients with advanced heart failure.
Pearl Toh, 6 days ago
The protective effects of liraglutide against the risks of cardiovascular (CV) events and deaths may be reduced in patients with type 2 diabetes (T2D) who experienced severe hypoglycaemia, but were independent of patient’s history of CV events at baseline, according to post hoc analyses of the LEADER* trial.
01 Aug 2015
A higher prevalence of coronary artery disease was reported among adult men than women with Kawasaki disease, a study shows.

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).

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 23 Nov 2017

The long-term mortality benefit conferred by mechanical over biologic prosthesis in valve replacement appears to be age- and location-dependent, according to findings of a US-based retrospective study.  

10 Jan 2018
Shared decision support with the use of standardized decision aids improves decision quality and reduces implantation of left ventricular assist device as destination therapy (DT-LVAD) in patients with advanced heart failure.
Pearl Toh, 6 days ago
The protective effects of liraglutide against the risks of cardiovascular (CV) events and deaths may be reduced in patients with type 2 diabetes (T2D) who experienced severe hypoglycaemia, but were independent of patient’s history of CV events at baseline, according to post hoc analyses of the LEADER* trial.
01 Aug 2015
A higher prevalence of coronary artery disease was reported among adult men than women with Kawasaki disease, a study shows.