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Renin-angiotensin-aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis
Wuxiang Xie1; Fanfan Zheng2; Xiaoyu Song3; Baoliang Zhong4; Li Yan5
Source PublicationInternational Journal of Cardiology
2016
Issue205Pages:65-71
Abstract

BACKGROUND:

Renin-angiotensin-aldosterone system (RAAS) blockers are effective therapies for heart failure and reduced ejection fraction (HFrEF) or left ventricular dysfunction (LVD). We aimed to assess the efficacy and safety of RAAS blockers in these patients.

METHODS:

We searched MEDLINE, EMBASE, and Cochrane Library in May 2015. Twenty-one double-blind randomized controlled trials (RCTs) with 69,229 patients were included this network meta-analysis.

RESULTS:

Compared with placebo, an angiotensin receptor-neprilysin inhibitor (ARNI) had the highest probability of reducing all-cause mortality (odds ratio [OR]=0.67, 95% credible interval [CrI]: 0.48-0.86), followed by an aldosterone receptor antagonist (ARA, OR=0.74, 95% CrI: 0.62-0.88) and an angiotensin-converting enzyme inhibitor (ACEI, OR=0.80, 95% CrI: 0.71-0.89). The most efficacious therapy for preventing heart failure hospitalization was ARNI (OR=0.55, 95% CrI: 0.40-0.71), followed by combination therapy with an angiotensin II receptor blocker (ARB) plus an ACEI (OR=0.61, 95% CrI: 0.49-0.75), then an ACEI alone (OR=0.69, 95% CrI: 0.61-0.77). Sensitivity analysis restricted to nine RCTs with a high background use of ACEI and/or ARB (>80%) indicated that adding an ARA to current standard therapy significantly reduced mortality (OR=0.73, 95% CrI: 0.51-0.95) and hospitalization risk (OR=0.67, 95% CrI: 0.47-0.87), but did not significantly increase the discontinuation risk (OR=1.29, 95% CrI: 0.83-2.31).

CONCLUSIONS:

ARNI has the highest probability of being the most efficacious therapy for HFrEF in reducing death and hospitalization for heart failure. ARA has the most favorable benefit-risk profile as an adjunct to background ACEI and/or ARB therapy.

Other Abstract英文摘要
KeywordHeart Failure And Reduced Ejection Fraction Left Ventricular Dysfunction Renin–angiotensin–aldosterone System
Document Type期刊论文
Identifierhttp://ir.ia.ac.cn/handle/173211/12121
Collection脑网络组研究中心
Corresponding AuthorWuxiang Xie
Affiliation1.Department of Epidemiology, Beijing Anzhen Hospital
2.Brainnetome Center, Institute of Automation, Chinese Academy of Sciences
3.Department of Biostatistics, Columbia University
4.Department of Psychiatry, University of Rochester Medical Center
5.Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
Recommended Citation
GB/T 7714
Wuxiang Xie,Fanfan Zheng,Xiaoyu Song,et al. Renin-angiotensin-aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis[J]. International Journal of Cardiology,2016(205):65-71.
APA Wuxiang Xie,Fanfan Zheng,Xiaoyu Song,Baoliang Zhong,&Li Yan.(2016).Renin-angiotensin-aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis.International Journal of Cardiology(205),65-71.
MLA Wuxiang Xie,et al."Renin-angiotensin-aldosterone system blockers for heart failure with reduced ejection fraction or left ventricular dysfunction: Network meta-analysis".International Journal of Cardiology .205(2016):65-71.
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