title: Efficacy of ACE inhibitors in chronic heart failure with preserved ejection fraction--a meta analysis of 7 prospective clinical studies.
abstract: BACKGROUND
  The effect of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction remains controversial.
  
  
  OBJECTIVE
  To assess the impact of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction.
  
  
  RESULTS
  Seven prospective studies evaluating the effect of ACE inhibitors compared to placebo or other classes of drugs, such as monotherapy or first-line therapy, on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction were included. A total of 2554 patients (mean age: 75.1 years, female: 58%) were recruited with an average follow up of 20.9 months. The primary etiology of heart failure with preserved ejection fraction was ischemic heart disease (33.7%), hypertension (69.1%) and diabetes mellitus (25.8%). Our results demonstrated that ACE inhibitors significantly reduced all-cause mortality (odds ratio, OR = 0.52; 95% Confidence Interval (CI), 0.41 to 0.64; P<0.01). Furthermore, ACE inhibitors were able to reduce heart failure related rehospitalization or treatment over 20.9 months (p<0.05) in a subgroup of patients aged over 75 years. However, death due to worsening of heart failure, heart failure related rehospitalization and any-cause readmission were not affected (OR = 0.88; 95% CI: 0.66 to 1.17; P = 0.37 for death due to worsening of heart failure; OR = 0.81; 95% CI: 0.63 to 1.05; P = 0.11 for heart failure related rehospitalization and OR = 0.88; 95% CI: 0.68 to 1.14; P = 0.33 for any-cause readmission, respectively).
  
  
  CONCLUSIONS
  In patients with chronic heart failure with preserved ejection fraction, ACE inhibitors reduced all-cause mortality without affecting mortality due to heart failure and any-cause rehospitalization.
authors.affiliation: Department of Cardiology, Shanghai Cardiovascular Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Mingqiang
authors.initials: M
authors.lastname: Fu
authors.forename: Jingmin
authors.initials: J
authors.lastname: Zhou
authors.forename: Aijun
authors.initials: A
authors.lastname: Sun
authors.forename: Shuning
authors.initials: S
authors.lastname: Zhang
authors.forename: Chunyu
authors.initials: C
authors.lastname: Zhang
authors.forename: Yunzeng
authors.initials: Y
authors.lastname: Zou
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
authors.forename: Junbo
authors.initials: J
authors.lastname: Ge
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors