TY - JOUR
T1 - Renin-Angiotensin System Inhibition, Worsening Renal Function, and Outcome in Heart Failure Patients With Reduced and Preserved Ejection Fraction A Meta-Analysis of Published Study Data
AU - Beldhuis, Iris E.
AU - Streng, Koen W.
AU - Ter Maaten, Jozine M.
AU - Voors, Adriaan A.
AU - van der Meer, Peter
AU - Rossignol, Patrick
AU - McMurray, John. J. V.
AU - Damman, Kevin
PY - 2017/2
Y1 - 2017/2
N2 - Background-Renin-angiotensin aldosterone system (RAAS) inhibitors significantly improve outcome in heart failure (HF) patients with reduced ejection fraction (HFREF), irrespective of the occurrence of worsening renal function (WRF). However, in HF patients with preserved ejection fraction (HFPEF), RAAS inhibitors have not been shown to improve outcome but are still frequently prescribed.Methods and Results-Random effect meta-analysis was performed to investigate the relationship between RAAS inhibitor therapy, WRF in both HF phenotypes, and mortality. Studies were selected based on literature search in MEDLNE and included randomized, placebo controlled trials of RAAS inhibitors in chronic HF. The primary outcome consisted of the interaction analysis for the association between RAAS inhibition-induced WRF, HF phenotype and outcome. A total of 8 studies (6 HFREF and 2 HFPEF, including 28 961 patients) were included in our analysis. WRF was more frequent in the RAAS inhibitor group, compared with the placebo group, in both HFREF and HFPEF. In HFREF, WRF induced by RAAS inhibitor therapy was associated with a less increased relative risk of mortality (relative risk, 1.19 (1.08-1.31); P <0.001), compared with WRF induced by placebo (relative risk, 1.48 (1.35-1.62); P <0.001; P for interaction 0.005). In contrast, WRF induced by RAAS inhibitor therapy was strongly associated with worse outcomes in HFPEF (relative risk, 1.78 (1.432.21); P <0.001), whereas placebo-induced WRF was not (relative risk, 1.25 (0.88-1.77); P=0.21; P for interaction 0.002).Conclusions-RAAS inhibitors induce renal dysfunction in both HFREF and HFPEF. However, in contrast to patients with HFREF where mortality increase with WRF is small, HFPEF patients with RAAS inhibitor-induced WRF have an increased mortality risk, without experiencing improved outcome with RAAS inhibition.
AB - Background-Renin-angiotensin aldosterone system (RAAS) inhibitors significantly improve outcome in heart failure (HF) patients with reduced ejection fraction (HFREF), irrespective of the occurrence of worsening renal function (WRF). However, in HF patients with preserved ejection fraction (HFPEF), RAAS inhibitors have not been shown to improve outcome but are still frequently prescribed.Methods and Results-Random effect meta-analysis was performed to investigate the relationship between RAAS inhibitor therapy, WRF in both HF phenotypes, and mortality. Studies were selected based on literature search in MEDLNE and included randomized, placebo controlled trials of RAAS inhibitors in chronic HF. The primary outcome consisted of the interaction analysis for the association between RAAS inhibition-induced WRF, HF phenotype and outcome. A total of 8 studies (6 HFREF and 2 HFPEF, including 28 961 patients) were included in our analysis. WRF was more frequent in the RAAS inhibitor group, compared with the placebo group, in both HFREF and HFPEF. In HFREF, WRF induced by RAAS inhibitor therapy was associated with a less increased relative risk of mortality (relative risk, 1.19 (1.08-1.31); P <0.001), compared with WRF induced by placebo (relative risk, 1.48 (1.35-1.62); P <0.001; P for interaction 0.005). In contrast, WRF induced by RAAS inhibitor therapy was strongly associated with worse outcomes in HFPEF (relative risk, 1.78 (1.432.21); P <0.001), whereas placebo-induced WRF was not (relative risk, 1.25 (0.88-1.77); P=0.21; P for interaction 0.002).Conclusions-RAAS inhibitors induce renal dysfunction in both HFREF and HFPEF. However, in contrast to patients with HFREF where mortality increase with WRF is small, HFPEF patients with RAAS inhibitor-induced WRF have an increased mortality risk, without experiencing improved outcome with RAAS inhibition.
KW - heart failure
KW - MEDLINE
KW - phenotype
KW - prognosis
KW - renin-angiotensin system
KW - CONVERTING-ENZYME-INHIBITOR
KW - RECEPTOR BLOCKER TREATMENT
KW - MYOCARDIAL-INFARCTION
KW - SYSTOLIC DYSFUNCTION
KW - RANDOMIZED-TRIAL
KW - BASE-LINE
KW - SPIRONOLACTONE
KW - EFFICACY
KW - THERAPY
KW - IMPACT
U2 - 10.1161/CIRCHEARTFAILURE.116.003588
DO - 10.1161/CIRCHEARTFAILURE.116.003588
M3 - Article
SN - 1941-3289
VL - 10
JO - Circulation-Heart failure
JF - Circulation-Heart failure
IS - 2
ER -