Effects of renin-angiotensin-aldosterone system inhibitors on mortality, hospitalization, and diastolic function in patients with HFpEF. A meta-analysis of 13 randomized controlled trials.
OBJECTIVE
The purpose of this meta-analysis was to evaluate the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on mortality, hospitalization, diastolic function, and exercise capacity in heart failure with preserved ejection fraction (HFpEF).


METHODS
Thirteen randomized controlled trials (RCTs), totaling 12,532 patients with HFpEF, were selected. All-cause and cardiovascular mortality, all-cause and heart failure-related hospitalization, diastolic function, and the 6-min walk distance were assessed. The risk ratios (RR) of the dichotomous data, weighted mean difference (WMD) of continuous data, and 95 % confidence intervals (CI) were calculated to assess the effects of RAAS inhibitors.


RESULTS
RAAS inhibitors significantly decreased heart failure-related hospitalization (RR 0.89; 95 % CI 0.82-0.97; p = 0.01) and improved the diastolic function, as reflected in a reduced E/e' index (MD -1.38; 95 % CI -2.01 to -0.74; p < 0.0001). However, there were no beneficial effects on all-cause cardiovascular mortality and all-cause hospitalization. Other diastolic parameters had few changes compared with the controls. The 6-min walk distance was not improved by the use of RAAS inhibitors.


CONCLUSIONS
In patients with HFpEF, RAAS inhibitors decreased heart-failure hospitalization and the E/e' index without affecting mortality, all-cause hospitalization, other diastolic function parameters, and the 6-min walk distance.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 210029, Jiangsu, China.
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Zhang
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 210029, Jiangsu, China.
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Chen
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 210029, Jiangsu, China.
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Liu
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 210029, Jiangsu, China. qjshan@njmu.edu.cn.|Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Guangzhou road 300, 210029, Nanjing, Jiangsu Province, China. qjshan@njmu.edu.cn.
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Shan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D015897:Comorbidity; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects*; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000517:prevention & control
D002316:Cardiotonic Agents
Angiotensin receptor; Angiotensin-converting enzyme inhibitors; Antagonists; Heart failure with preserved ejection fraction; Mineralocorticoid-receptor antagonists