Renin–angiotensin–aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis

Xie, Wuxiang; Zheng, Feihu; Song, Xiaoyu; Zhong, Bao‐Liang; Li, Yan

doi:10.1016/j.ijcard.2015.12.010

Cited by 24 publications

(21 citation statements)

References 42 publications

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“…79–85 A recent putative placebo analysis by McMurray et al 86 found that ARNI was associated with a 28% reduction in all-cause mortality, which was similar to the sensitivity analysis performed that ignored background therapy (ie, 29% reduction in all-cause mortality).…”

Section: Discussionmentioning

confidence: 62%

Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction

Burnett

Earley

Voors

et al. 2017

Circ: Heart Failure

198

152

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Section: Discussionmentioning

confidence: 62%

Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction

Burnett

Earley

Voors

et al. 2017

Circ: Heart Failure

198

152

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“…However, RAS inhibitors have potentially irreplaceable clinical significance because of their ability to improve outcomes. Many studies have investigated the possible benefits of ACEI/ARB treatment for renal transplant recipients, including the roles of controlling hypertension, reducing proteinuria and managing cardiovascular disease [1,10,11,52]. Despite this, and despite prescriptions for RAS inhibitors increasing from <20% in the early 1990s to >45% in the 2000s [19,53], there is no consensus on the benefits they offer for either patient or graft survival.…”

Section: Discussionmentioning

confidence: 99%

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Jiang

Song

Qiu

et al. 2017

The Kaohsiung J of Med Scie

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Renin-angiotensin system inhibitors, specifically angiotensin II converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), have confirmed renoprotective benefits in patients with proteinuria and hypertension. However, it remains controversial whether these agents are beneficial to kidney recipients. We conducted this meta-analysis to evaluate the effects of ACEI/ARB treatment on patient and allograft survival after kidney transplant. The PubMed, Embase and Cochrane Library databases were searched for eligible articles from before May 2016, and we included 24 articles (9 randomised controlled trials [RCTs] and 15 cohort studies with 54,096 patients), in which patient or graft survival was compared between an ACEI/ARB treatment arm and a control arm. Pooled results showed that ACEI/ARB was associated with decreased risks of patient death (relative risk [RR] = 0.64; 95% confidence interval [CI]:0.49-0.84) and graft loss (RR = 0.59; 95%CI:0.47-0.74). Subgroup analysis of the cohorts revealed significantly reduced patient death (RR = 0.61; 95%CI:0.50-0.74) and graft loss (RR = 0.58; 95%CI:0.46-0.73), but this was not seen in RCTs (patient survival: RR = 0.84, 95%CI:0.39-1.81; graft survival: RR = 0.70, 95%CI:0.17-2.79). Significantly less graft loss was noted among patients with biopsy-proved chronic allograft nephropathy (CAN) (RR = 0.26, 95%CI:0.16-0.44). Furthermore, the benefit of ACEI/ARB on patient survival (RR = 0.62; 95%CI:0.47-0.83) and graft survival (RR = 0.58, 95%CI:0.47-0.71) was limited to those with ≥3years' follow-up. ACEI/ARB decreased proteinuria (P < 0.001) and lowered haemoglobin (P = 0.002), but the haemoglobin change requires no additional treatment (from 119-131 g/L to 107-123 g/L). We therefore concluded that ACEI/ARB treatment may reduce patient death and graft loss, but additional well-designed prospective studies are needed to validate these findings.

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“…In the general population, renin-angiotensin system (RAS) antagonists reduce cardiovascular morbidity and mortality through primary or secondary prevention, as has been summarized in a number of meta-analyses [1–8]. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have demonstrated efficacy in reducing all-cause mortality and myocardial infarction in people with ischemic heart disease [1], hypertension [3, 4], heart failure [5], and diabetes [7].…”

Section: Introductionmentioning

confidence: 99%

“…Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have demonstrated efficacy in reducing all-cause mortality and myocardial infarction in people with ischemic heart disease [1], hypertension [3, 4], heart failure [5], and diabetes [7]. Results for patients with heart failure are less consistent across study settings but are generally favorable toward RAS agents compared to controls [5, 8–10]. Several foundational trials in non-dialysis patients such as the Studies of Left Ventricular Dysfunction (SOLVD) [11], Survival and Ventricular Enlargement (SAVE) trial [12], and Trandolopril Cardiac Evaluation (TRACE) [13] demonstrated all-cause and cardiovascular mortality benefits in patients with reduced ejection fraction, although patients with preserved systolic function may not benefit from these therapies [14, 15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Effectiveness of Renin-Angiotensin System Antagonists in Maintenance Dialysis Patients

Shireman

Mahnken²,

Phadnis³

et al. 2016

Kidney Blood Press Res

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Background/Aims: Whether angiotensin converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) are differentially associated with reductions in cardiovascular events and mortality in patients receiving maintenance dialysis is uncertain. We compared outcomes between ACE and ARB users among hypertensive, maintenance dialysis patients. Methods: National retrospective cohort study of hypertensive, Medicare-Medicaid eligible patients initiating chronic dialysis between 1/1/2000 to 12/31/2005. The exposure of interest was new use of either an ACEI or ARB. Outcomes were all-cause mortality (ACM) and combined cardiovascular hospitalization or death (CV-endpoint). Cox proportion hazards models were used to compare the effect of ACEI vs ARB use on ACM and, separately, CV-endpoint. Results: ACM models were based on 3,555 ACEI and 1,442 ARB new users, while CV-endpoint models included 3,289 ACEI and 1,346 ARB new users. After statistical adjustments, ACEI users had higher hazard ratios for ACM (AHR = 1.22, 99% CI 1.05-1.42) and CV-endpoint (AHR = 1.12, 99% CI 0.99-1.27). Conclusions: Patients initiating maintenance dialysis who received an ACEI faced an increased risk for mortality and a trend towards an increased risk for CV-endpoints when compared to patients who received an ARB. Validation of these results in a rigorous clinical trial is warranted.

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Renin–angiotensin–aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis

Cited by 24 publications

References 42 publications

Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction

Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Comparative Effectiveness of Renin-Angiotensin System Antagonists in Maintenance Dialysis Patients

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