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Effects of renin–angiotensin–aldosterone system inhibitors on mortality, hospitalization, and diastolic function in patients with HFpEF

A meta-analysis of 13 randomized controlled trials

Auswirkungen der Inhibitoren des Renin-Angiotensin-Aldosteron-Systems auf Mortalität, Hospitalisation und diastolische Funktion bei Patienten mit HFpEF

Eine Metaanalyse von 13 randomisierten kontrollierten Studien

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Abstract

Aim

The purpose of this meta-analysis was to evaluate the effects of renin–angiotensin–aldosterone system (RAAS) inhibitors on mortality, hospitalization, diastolic function, and exercise capacity in heart failure with preserved ejection fraction (HFpEF).

Methods

Thirteen randomized controlled trials (RCTs), totaling 12,532 patients with HFpEF, were selected. All-cause and cardiovascular mortality, all-cause and heart failure-related hospitalization, diastolic function, and the 6-min walk distance were assessed. The risk ratios (RR) of the dichotomous data, weighted mean difference (WMD) of continuous data, and 95 % confidence intervals (CI) were calculated to assess the effects of RAAS inhibitors.

Results

RAAS inhibitors significantly decreased heart failure-related hospitalization (RR 0.89; 95 % CI 0.82–0.97; p = 0.01) and improved the diastolic function, as reflected in a reduced E/e’ index (MD −1.38; 95 % CI −2.01 to −0.74; p < 0.0001). However, there were no beneficial effects on all-cause cardiovascular mortality and all-cause hospitalization. Other diastolic parameters had few changes compared with the controls. The 6-min walk distance was not improved by the use of RAAS inhibitors.

Conclusion

In patients with HFpEF, RAAS inhibitors decreased heart-failure hospitalization and the E/e’ index without affecting mortality, all-cause hospitalization, other diastolic function parameters, and the 6-min walk distance.

Zusammenfassung

Ziel

Ziel dieser Metaanalyse war es, die Auswirkungen der Inhibitoren des Renin-Angiotensin-Aldosteron-Systems (RAAS) auf Mortalität, Hospitalisation, diastolische Funktion und körperliche Belastbarkeit bei Herzversagen mit konservierter Ejektionsfraktion (HFpEF) zu evaluieren.

Methoden

Dreizehn randomisierte kontrollierte Studien (RCTs) mit insgesamt 12.532 HFpEF-Patienten wurden ausgewählt. Die kardiovaskuläre und Gesamtmortalität sowie die durch Herzversagen bedingte Hospitalisation, diastolische Funktion und die 6-min-Gehstrecke wurden beurteilt. Das relative Risiko (RR) der dichotomen Daten, die gewichtete mittlere Differenz ("weighted mean difference", WMD) der kontinuierlichen Daten und das 95% Konfidenzintervall (CI) wurden berechnet, um die Auswirkungen der RAAS-Inhibitoren zu untersuchen.

Ergebnisse

RAAS-Inhibitoren senkten Herzversagen-bedingte Hospitalisation signifikant (RR 0,89; 95% CI 0,82–0,97; p=0,01) und verbesserten die diastolische Funktion, wie ein reduzierter E/e’-Index (MD −1,38; 95% CI −2,01 bis −0,74; p<0,0001) zeigt. Jedoch gab es keine positiven Auswirkungen auf die kardiovaskuläre und Gesamtmortalität und Gesamthospitalisierung. Bei anderen diastolischen Parametern gab es im Vergleich zur Kontrollgruppe nur geringe Abweichungen.

Schlussfolgerung

Bei Patienten mit HFpEF reduzierten RAAS-Inhibitoren die Hospitalisation wegen Herzversagens sowie den E/e'-Index, ohne die Mortalität, Gesamthospitalisationsrate, andere diastolische Funktionsparameter und die 6-min-Gestrecke zu beeinflussen.

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Acknowledgments

This study was supported by the National Natural Science Foundation of China, No.30570746. All of the authors thank the statistics teacher, Honggang Yi, from Nanjing Medical University, for his helpful knowledge of evidence-based medicine.

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 210029, Jiangsu, China

    Q. Zhang, Y. Chen, Q. Liu & Q. Shan

  2. Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou road 300, 210029, Nanjing, Jiangsu Province, China

    Q. Shan

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Qi Zhang, Yanhong Chen, Qian Liu, Qijun Shan state that there are no conflicts of interest.

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Zhang, Q., Chen, Y., Liu, Q. et al. Effects of renin–angiotensin–aldosterone system inhibitors on mortality, hospitalization, and diastolic function in patients with HFpEF. Herz 41, 76–86 (2016). https://doi.org/10.1007/s00059-015-4346-8

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  • DOI: https://doi.org/10.1007/s00059-015-4346-8

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