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Effects of Angiotensin II Receptor Blockers on Ventricular Hypertrophy in Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials

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Abstract

Purpose

Animal studies have suggested that angiotensin II receptor blockers (ARBs) can attenuate or reverse the progression of hypertrophic cardiomyopathy, while clinical studies yielded conflicting results. We sought to conduct a meta-analysis to investigate the effect of ARBs in patients with hypertrophic cardiomyopathy.

Methods

PubMed and EMBASE databases were searched through June 2020. Only randomized controlled trials (RCTs) were included, and each study’s quality was assessed using the Jadad scale. The primary outcome was left ventricular mass reduction, and the secondary outcome was the change in left ventricular ejection fraction (LVEF). Data were pooled using the random effects model.

Results

A total of 1294 articles were screened. Five RCTs were included in the final analysis, enrolling 209 patients with hypertrophic cardiomyopathy (101 patients were in the ARB arm). ARB treatment was not associated with either significant left ventricular mass reduction (standardized mean difference: − 0.25; 95% CI: − 0.73, 0.22; p = 0.29) or change in LVEF (weighted mean difference: 0.73%; 95% CI: − 1.10%, 2.56%; p = 0.43). Subgroup analysis showed that losartan, one of the most investigated and commonly used ARBs, was also not associated with significant decreases of left ventricular mass (standardized mean difference: − 0.13; 95% CI: − 0.61, 0.36; p = 0.61).

Conclusion

This meta-analysis showed that ARB treatment is not associated with reduced left ventricular mass nor remarkable LVEF change among patients with hypertrophic cardiomyopathy. Further studies with a larger number of patients will be required to confirm these findings.

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Data Availability

Data are available upon request.

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Acknowledgments

The authors would like to thank Dr. Paul Bain from Harvard University Countway Library of Medicine for his guidance and assistance in the literature search. The authors also would like to thank Dr. Stefania Papatheodorou, faculty of the Harvard T.H. Chan School of Public Health, for her advice and assistance in conducting the analysis.

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Author notes

  1. Ye Liu

    Present address: Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA

  2. Kanako Teramoto

    Present address: Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

  3. Thanan Supasiri

    Present address: Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

  4. Kanhua Yin

    Present address: Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

  5. Ye Liu, Kanako Teramoto, Vicki K. Wing and Thanan Supasiri contributed equally to this work.

Authors and Affiliations

  1. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Ye Liu, Kanako Teramoto, Vicki K. Wing, Thanan Supasiri & Kanhua Yin

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Contributions

KT and KY conceived and designed the research; YL, KT, TS, and KY reviewed articles; VKW and TS extracted the data; YL and TS analyzed the data; YL, KT, VKW, and TS drafted the manuscript and interpreted the results; KY made critical revision of the manuscript. All authors approved the submission of the final manuscript.

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Correspondence to Kanhua Yin.

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Liu, Y., Teramoto, K., Wing, V.K. et al. Effects of Angiotensin II Receptor Blockers on Ventricular Hypertrophy in Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials. Cardiovasc Drugs Ther 36, 371–378 (2022). https://doi.org/10.1007/s10557-020-07118-2

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