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Efficacy of aliskiren supplementation for heart failure

A meta-analysis of randomized controlled trials

Wirksamkeit der Aliskiren-Supplementierung bei Herzinsuffizienz

Eine Metaanalyse randomisierter kontrollierter Studien

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Abstract

Background

Aliskiren might be beneficial for heart failure. However, the results of various studies are controversial. We conducted a systematic review and meta-analysis to explore the efficacy of aliskiren supplementation for heart failure.

Methods

PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of aliskiren for heart failure were included. Two investigators independently searched for articles, extracted data, and assessed the quality of included studies. The meta-analysis was performed using the random-effect model.

Results

Five RCTs comprising 1973 patients were included in the meta-analysis. Compared with control interventions in heart failure, aliskiren supplementation was found to significantly reduce NT-proBNP levels (standardized mean difference [SMD] = −0.12; 95% CI = −0.21 to −0.03 pg/ml; p = 0.008) and plasma renin activity (SMD = −0.66; 95% CI = −0.89 to −0.44 ng/ml.h; p < 0.00001) while increasing plasma renin concentration (SMD = 0.52; 95% CI = 0.30–0.75 ng/l; p < 0.00001); however, it demonstrated no significant influence on BNP levels (SMD = −0.08; 95% CI = −0.31–0.15 pg/ml; p = 0.49), mortality (RR = 0.97; 95% CI = 0.79–1.20; p = 0.79), aldosterone levels (SMD = −0.09; 95% CI = −0.32–0.14 pmol/l; p = 0.44), adverse events (RR = 3.03; 95% CI = 0.18–49.51; p = 0.44), and serious adverse events (RR = 1.34; 95% CI = 0.54–3.33; p = 0.53).

Conclusion

Aliskiren supplementation was found to significantly decrease NT-proBNP levels and plasma renin activity and to improve plasma renin concentration in the setting of heart failure.

Zusammenfassung

Hintergrund

Aliskiren könnte vorteilhaft bei Herzinsuffizienz wirken. Jedoch führten verschiedene Studien zu kontroversen Ergebnissen. Die Autoren erstellten eine systematische Übersicht und Metaanalyse, um die Wirksamkeit der Supplementierung von Aliskiren bei Herzinsuffizienz zu ermitteln.

Methoden

Die Datenbanken PubMed, Embase, Web of Science, EBSCO und die Cochrane Library wurden systematisch durchsucht. In die Auswertung aufgenommen wurden randomisierte kontrollierte Studien, in denen die Wirksamkeit von Aliskiren bei Herzinsuffizienz untersucht wurde. Zwei Untersucher ermittelten unabhängig voneinander entsprechende Beiträge, extrahierten Daten und bewerteten die Qualität der in die Auswertung aufgenommenen Studien. Für die Durchführung der Metaanalyse wurde das Random-Effects-Modell eingesetzt.

Ergebnisse

Es wurden 5 Studien mit 1973 Patienten in die Metaanalyse eingeschlossen. Im Vergleich zu Kontrollinterventionen bei Herzinsuffizienz zeigte sich, dass die Supplementierung von Aliskiren zu einer signifikanten Senkung der Werte für NT-proBNP (n-terminales „pro brain natriuretic peptide“; standardisierte Mittelwertdifferenz, SMD: −0,12; 95%-Konfidenzintervall, 95%-KI: −0,21 bis −0,03 pg/ml; p = 0,008) und Plasmareninaktivität (SMD: −0,66; 95% -KI: −0,89 bis −0,44 ng/ml.h; p < 0,00001) führte, während es zum Anstieg der Plasmareninkonzentration kam (SMD: 0,52; 95% -KI: 0,30–0,75 ng/l; p < 0,00001); jedoch zeigte sich kein signifikanter Einfluss auf den BNP-Wert (SMD: −0,08; 95% -KI: −0,31–0,15 pg/ml; p = 0,49), die Mortalität (relatives Risiko, RR: 0,97; 95% -KI: 0,79–1,20; p = 0,79), Aldosteronwerte (SMD: −0,09; 95% -KI: −0,32–0,14 pmol/l; p = 0,44), unerwünschte Ereignisse (RR: 3,03; 95% -KI: 0,18–49,51; p = 0,44) und schwere unerwünschte Ereignisse (RR: 1,34; 95% -KI: 0,54–3,33; p = 0,53).

Schlussfolgerung

Es stellte sich heraus, dass die Supplementierung von Aliskiren im Rahmen einer Herzinsuffizienz zu einer signifikanten Senkung der Werte für NT-proBNP und für die Plasmareninaktivität führte sowie zur Verbesserung der Plasmareninkonzentration.

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Authors and Affiliations

  1. Department of Cardiology Medical, Jiangjin Central Hospital of Chongqing, No. 725 Jiangzhou Road Jiangjin District, 402260, Chongqing, China

    Y. Luo & Q. Chen

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  1. Y. Luo
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  2. Q. Chen
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Correspondence to Q. Chen.

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Y. Luo and Q. Chen declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Luo, Y., Chen, Q. Efficacy of aliskiren supplementation for heart failure. Herz 44, 398–404 (2019). https://doi.org/10.1007/s00059-018-4679-1

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