Comparative associations between angiotensin converting enzyme inhibitors, angiotensin receptor blockers and their combination, and outcomes in patients with heart failure and reduced ejection fraction. (15th November 2015)

• Record Type: Journal Article
• Authors: Savarese, Gianluigi; Edner, Magnus; Dahlström, Ulf; Perrone-Filardi, Pasquale; Hage, Camilla; Cosentino, Francesco; Lund, Lars H.
• Is Part Of: International journal of cardiology. Volume 199(2015)
• Page Start: 415
• Page End: 423
• Publication Date: 2015-11-15
• Subjects: Heart failure with reduced ejection fraction -- Angiotensin converting enzyme inhibitors -- Angiotensin receptor blockers -- Registry -- Prognosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.07.051
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are recommended in heart failure with reduced ejection fraction (HFREF), but there is limited data on ARB vs. ACE-I and their combination in unselected populations. The purpose of this study was to compare the associations between the use of ACE-I, ARB and their combination, and outcomes in HFREF. Methods and results: We prospectively studied 22, 947 patients with HFREF (ejection fraction < 40%) enrolled in the Swedish Heart Failure Registry who received ACE-I but not ARB (n = 15, 801, 69%), ARB but not ACE-I (n = 4335, 19%), their combination (n = 571, 2%) or neither (n = 2240, 10%). As compared with ACE-I alone, the hazard ratios (HRs) for ARB alone for all-cause mortality was 0.97 (95% CI = 0.91–1.03; p = 0.27), for HF hospitalization 1.08 (CI = 1.02–1.15; p < 0.01) and for the composite outcome 1.03 (CI = 0.99–1.08; p = 0.15). ACE-I and ARB combination had for death HR = 0.98 (95% CI = 0.84–1.14; p = 0.76), for HF hospitalization HR = 1.49 (CI = 1.33–1.68; p < 0.01) and for the composite outcome HR = 1.35 (CI = 1.21–1.50; p < 0.01). Use of neither ACE-I nor ARB was associated with HR for death 1.41 (CI = 1.33–1.50; p < 0.01), for HF hospitalization 1.16 (CI = 1.08–1.25; p < 0.01) and for the composite outcome 1.28 (CI = 1.21–1.35; p < 0.01). Conclusion: This large generalizable analysis confirms the current recommendation of using ACE-I as first choice in HFREF. ARB can be considered an alternative in patients who cannot use ACE-I but should not routinely replace ACE-I. The combination of ACE-I and ARB was not associated with additional benefit over either one alone, and may potentially be harmful.