Efficacy and Safety of ACEI/ARB for Patients with Diastolic Heart Failure: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 HEQian-wen ¹ , FENGYing ¹ , WENYin-xian ² , ZHOUYou ¹ ,  WANGYang-gan ¹

1. Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China;
2. Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China;

Corresponding?author：

WANGYang-gan, Email: ygwang2013@163.com

Keywords：

Diastolic heart failure; Heart failure with preserved ejection fraction; Angiotensin-converting enzyme inhibitor; Angiotensin receptor blocker; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150112

Video：

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Objective To systematically review the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) in the treatment of patients with diastolic heart failure (DHF). Methods PubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data, VIP and CBM were electronically searched from inception to November 2014 for randomized controlled trials (RCTs) of ACEI/ARB for DHF patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 22 RCTs involving 9 557 patients were included. The results of meta-analysis indicated that, compared with the control group, the ACEI/ARB group had significant improvements in exercise capacity (6-minute walk distance:SMD=0.02, 95% CI 0.05 to 0.38, P=0.01; Exercise time:MD=40.58, 95% CI 14.06 to 67.10, P=0.003) and diastolic function (E/A ratio:MD=0.20, 95% CI 0.09 to 0.31, P=0.000 4; E/E' ratio:MD=-1.69, 95% CI -2.11 to -1.27, P<0.000 01). In addition, compared with the control treatment, ACEI/ARB could significantly decrease the serum BNP level (SMD=-0.44, 95% CI -0.72 to -0.16, P=0.002) and NT-proBNP level (SMD=-0.68, 95% CI -1.24 to -0.12, P=0.02). Conclusion Current evidence shows that ACEI/ARB can improve the exercise capacity and diastolic function, and reduce the levels of serum BNP and NT-proBNP in DHF patients. Due to the limited quality of the included studies and discrepancies in the diagnostic criteria of DHF, more high-quality studies are needed to verify the above conclusion.

Citation： HEQian-wen, FENGYing, WENYin-xian, ZHOUYou, WANGYang-gan. Efficacy and Safety of ACEI/ARB for Patients with Diastolic Heart Failure: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 672-680. doi: 10.7507/1672-2531.20150112 Copy

1.	Go AS,Mozaffarian D,Roger VL,et al.Heart disease and stroke statistics--2014 update:a report from the American Heart Association.Circulation,2014,129(3):e28-e292.
2.	顧東風,黃廣勇,何江,等.中國心力衰竭流行病學調查及其患病率.中華心血管病雜志,2003,31(1):3-6.
3.	Roger VL,Weston SA,Redfield MM,et al.Trends in heart failure incidence and survival in a community-based population.JAMA,2004,292(3):344-350.
4.	Levy D,Kenchaiah S,Larson MG,et al.Long-term trends in the incidence of and survival with heart failure.N Engl J Med,2002,347(18):1397-1402.
5.	Suter LG,Li SX,Grady JN,et al.National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction,heart failure,and pneumonia:update on publicly reported outcomes measures based on the 2013 release.J Gen Intern Med,2014,29(10):1333-1340.
6.	Tribouilloy C,Rusinaru D,Mahjoub H,et al.Prognosis of heart failure with preserved ejection fraction:a 5 year prospective population-based study.Eur Heart J,2008,29(3):339-347.
7.	Owan TE,Hodge DO,Herges RM,et al.Trends in prevalence and outcome of heart failure with preserved ejection fraction.N Engl J Med,2006,355(3):251-259.
8.	Fonarow GC,Stough WG,Abraham WT,et al.Characteristics,treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry.J Am Coll Cardiol,2007,50(8):768-777.
9.	Writing Committee Members,Yancy CW,Jessup M,et al.2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation,2013,128(16):e240-327.
10.	Yusuf S,Pfeffer MA,Swedberg K,et al.Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction:the CHARM-Preserved Trial.Lancet,2003,362(9386):777-781.
11.	Cleland JG,Tendera M,Adamus J,et al.The perindopril in elderly people with chronic heart failure (PEP-CHF) study.Eur Heart J,2006,27(19):2338-2345.
12.	Massie BM,Carson PE,McMurray JJ,et al.Irbesartan in patients with heart failure and preserved ejection fraction.N Engl J Med,2008,359(23):2456-2467.
13.	Dickstein K,Cohen-Solal A,Filippatos G,et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).Eur Heart J,2008,29(19):2388-2442.
14.	中華醫學會心血管病學分會,《中華心血管病雜志》編輯委員會.慢性心力衰竭診斷治療指南2007.中華心血管病雜志,2007,35(12):1089-1090.
15.	共識專家組.射血分數正常心力衰竭診治的中國專家共識.中國醫刊,2010,45(11):63-67.
16.	Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane-handbook.org.
17.	Aronow WS,Kronzon I.Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction.Am J Cardiol,1993,71(7):602-604.
18.	Zi M,Carmichael N,Lye M.The effect of quinapril on functional status of elderly patients with diastolic heart failure.Cardiovasc Drugs Ther,2003,17(2):133-139.
19.	Kasama S,Toyama T,Kumakura H,et al.Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction.J Am Coll Cardiol,2005,45(5):661-667.
20.	趙林雙,向光大,周子華,等.纈沙坦治療高血壓病合并舒張性心功能不全116例.中國新藥與臨床雜志,2006,25(10):762-765.
21.	Yip GW,Wang M,Wang T,et al.The Hong Kong diastolic heart failure study:a randomised controlled trial of diuretics,irbesartan and ramipril on quality of life,exercise capacity,left ventricular global and regional function in heart failure with a normal ejection fraction.Heart,2008,94(5):573-580.
22.	Parthasarathy HK,Pieske B,Weisskopf M,et al.A randomized,double-blind,placebo-controlled study to determine the effects of valsartan on exercise time in patients with symptomatic heart failure with preserved ejection fraction.Eur J Heart Fail,2009,11(10):980-989.
23.	Kitzman DW,Hundley WG,Brubaker PH,et al.A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction:effects on exercise tolerance and arterial distensibility.Circ Heart Fail,2010,3(4):477-485.
24.	廖志勇,鄭巍,鐘新波,等.纈沙坦與卡維地洛治療左室射血分數正常的心力衰竭臨床觀察.廣東醫學,2010,31(17):2302-2304.
25.	陳彩萍,徐承.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭療效觀察.山東醫藥,2011,51(35):80-81.
26.	何中涵,周煒,陳曼華.貝拉普利與琥珀酸美托洛爾治療左室射血分數正常的心力衰竭臨床觀察.臨床心血管病雜志,2011,27(9):667-669.
27.	張紅穎,甄懷蒙,趙若雷.六分鐘步行試驗對左室射血分數正常的心力衰竭患者活動耐力評估.中國醫師進修雜志,2011,34(31):63-65.
28.	滕景俠.貝拉普利與琥珀酸美托洛爾治療左室射血分數正常的心力衰竭臨床研究.中國當代醫藥,2012,19(14):72-73.
29.	謝英,段珊瑚,湯惠高.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭療效研究.中外醫療,2012,31(23):92-94.
30.	陳四喜,王麗娟,燕學波,等.厄貝沙坦對高血壓患者左室舒張功能的影響.實用醫藥雜志,2013,30(7):588-589.
31.	周春麗.替米沙坦聯合氨氯地平治療心力衰竭的療效.中國藥物經濟學,2013,(8):242-243.
32.	梁震林.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭的臨床研究.當代醫學,2014,20(23):141-142.
33.	秦海斌.琥珀酸美托洛爾等藥品對左室射血分數正常心力衰竭患者的影響.現代養生,2014,(14):83-83.
34.	尚伶俐,李玉霞,徐貴琴.纈沙坦聯合美托洛爾治療舒張性心力衰竭效果觀察.疾病監測與控制雜志,2014,8(6):395-396.
35.	張朝華.厄貝沙坦治療高血壓并射血分數正常的心力衰竭的觀察.中國保健營養,2014,24(2):684-684.
36.	Borlaug BA,Paulus WJ.Heart failure with preserved ejection fraction:pathophysiology,diagnosis,and treatment.Eur Heart J,2011,32(6):670-679.
37.	Yamamoto K,Masuyama T,Sakata Y,et al.Roles of renin-angiotensin and endothelin systems in development of diastolic heart failure in hypertensive hearts.Cardiovasc Res,2000,47(2):274-283.
38.	Akuzawa N,Nakamura T,Kurashina T,et al.Antihypertensive agents prevent nephrosclerosis and left ventricular hypertrophy induced in rats by prolonged inhibition of nitric oxide synthesis.Am J Hypertens,1998,11(6 Pt 1):697-707.
39.	Nagai M,Horikoshi K,Izumi T,et al.Cardioprotective action of perindopril versus candesartan in renovascular hypertensive rats.Cardiovasc Drugs Ther,2004,18(5):353-362.
40.	Porteri E,Rodella L,Rizzoni D,et al.Effects of olmesartan and enalapril at low or high doses on cardiac,renal and vascular interstitial matrix in spontaneously hypertensive rats.Blood Press,2005,14(3):184-192.
41.	Agarwal V,Briasoulis A,Messerli FH.Effects of renin-angiotensin system blockade on mortality and hospitalization in heart failure with preserved ejection fraction.Heart Fail Rev,2013,18(4):429-437.

1. Go AS,Mozaffarian D,Roger VL,et al.Heart disease and stroke statistics--2014 update:a report from the American Heart Association.Circulation,2014,129(3):e28-e292.
2. 顧東風,黃廣勇,何江,等.中國心力衰竭流行病學調查及其患病率.中華心血管病雜志,2003,31(1):3-6.
3. Roger VL,Weston SA,Redfield MM,et al.Trends in heart failure incidence and survival in a community-based population.JAMA,2004,292(3):344-350.
4. Levy D,Kenchaiah S,Larson MG,et al.Long-term trends in the incidence of and survival with heart failure.N Engl J Med,2002,347(18):1397-1402.
5. Suter LG,Li SX,Grady JN,et al.National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction,heart failure,and pneumonia:update on publicly reported outcomes measures based on the 2013 release.J Gen Intern Med,2014,29(10):1333-1340.
6. Tribouilloy C,Rusinaru D,Mahjoub H,et al.Prognosis of heart failure with preserved ejection fraction:a 5 year prospective population-based study.Eur Heart J,2008,29(3):339-347.
7. Owan TE,Hodge DO,Herges RM,et al.Trends in prevalence and outcome of heart failure with preserved ejection fraction.N Engl J Med,2006,355(3):251-259.
8. Fonarow GC,Stough WG,Abraham WT,et al.Characteristics,treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry.J Am Coll Cardiol,2007,50(8):768-777.
9. Writing Committee Members,Yancy CW,Jessup M,et al.2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.Circulation,2013,128(16):e240-327.
10. Yusuf S,Pfeffer MA,Swedberg K,et al.Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction:the CHARM-Preserved Trial.Lancet,2003,362(9386):777-781.
11. Cleland JG,Tendera M,Adamus J,et al.The perindopril in elderly people with chronic heart failure (PEP-CHF) study.Eur Heart J,2006,27(19):2338-2345.
12. Massie BM,Carson PE,McMurray JJ,et al.Irbesartan in patients with heart failure and preserved ejection fraction.N Engl J Med,2008,359(23):2456-2467.
13. Dickstein K,Cohen-Solal A,Filippatos G,et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008:the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).Eur Heart J,2008,29(19):2388-2442.
14. 中華醫學會心血管病學分會,《中華心血管病雜志》編輯委員會.慢性心力衰竭診斷治療指南2007.中華心血管病雜志,2007,35(12):1089-1090.
15. 共識專家組.射血分數正常心力衰竭診治的中國專家共識.中國醫刊,2010,45(11):63-67.
16. Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane-handbook.org.
17. Aronow WS,Kronzon I.Effect of enalapril on congestive heart failure treated with diuretics in elderly patients with prior myocardial infarction and normal left ventricular ejection fraction.Am J Cardiol,1993,71(7):602-604.
18. Zi M,Carmichael N,Lye M.The effect of quinapril on functional status of elderly patients with diastolic heart failure.Cardiovasc Drugs Ther,2003,17(2):133-139.
19. Kasama S,Toyama T,Kumakura H,et al.Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction.J Am Coll Cardiol,2005,45(5):661-667.
20. 趙林雙,向光大,周子華,等.纈沙坦治療高血壓病合并舒張性心功能不全116例.中國新藥與臨床雜志,2006,25(10):762-765.
21. Yip GW,Wang M,Wang T,et al.The Hong Kong diastolic heart failure study:a randomised controlled trial of diuretics,irbesartan and ramipril on quality of life,exercise capacity,left ventricular global and regional function in heart failure with a normal ejection fraction.Heart,2008,94(5):573-580.
22. Parthasarathy HK,Pieske B,Weisskopf M,et al.A randomized,double-blind,placebo-controlled study to determine the effects of valsartan on exercise time in patients with symptomatic heart failure with preserved ejection fraction.Eur J Heart Fail,2009,11(10):980-989.
23. Kitzman DW,Hundley WG,Brubaker PH,et al.A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction:effects on exercise tolerance and arterial distensibility.Circ Heart Fail,2010,3(4):477-485.
24. 廖志勇,鄭巍,鐘新波,等.纈沙坦與卡維地洛治療左室射血分數正常的心力衰竭臨床觀察.廣東醫學,2010,31(17):2302-2304.
25. 陳彩萍,徐承.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭療效觀察.山東醫藥,2011,51(35):80-81.
26. 何中涵,周煒,陳曼華.貝拉普利與琥珀酸美托洛爾治療左室射血分數正常的心力衰竭臨床觀察.臨床心血管病雜志,2011,27(9):667-669.
27. 張紅穎,甄懷蒙,趙若雷.六分鐘步行試驗對左室射血分數正常的心力衰竭患者活動耐力評估.中國醫師進修雜志,2011,34(31):63-65.
28. 滕景俠.貝拉普利與琥珀酸美托洛爾治療左室射血分數正常的心力衰竭臨床研究.中國當代醫藥,2012,19(14):72-73.
29. 謝英,段珊瑚,湯惠高.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭療效研究.中外醫療,2012,31(23):92-94.
30. 陳四喜,王麗娟,燕學波,等.厄貝沙坦對高血壓患者左室舒張功能的影響.實用醫藥雜志,2013,30(7):588-589.
31. 周春麗.替米沙坦聯合氨氯地平治療心力衰竭的療效.中國藥物經濟學,2013,(8):242-243.
32. 梁震林.替米沙坦聯合氨氯地平治療射血分數正常的心力衰竭的臨床研究.當代醫學,2014,20(23):141-142.
33. 秦海斌.琥珀酸美托洛爾等藥品對左室射血分數正常心力衰竭患者的影響.現代養生,2014,(14):83-83.
34. 尚伶俐,李玉霞,徐貴琴.纈沙坦聯合美托洛爾治療舒張性心力衰竭效果觀察.疾病監測與控制雜志,2014,8(6):395-396.
35. 張朝華.厄貝沙坦治療高血壓并射血分數正常的心力衰竭的觀察.中國保健營養,2014,24(2):684-684.
36. Borlaug BA,Paulus WJ.Heart failure with preserved ejection fraction:pathophysiology,diagnosis,and treatment.Eur Heart J,2011,32(6):670-679.
37. Yamamoto K,Masuyama T,Sakata Y,et al.Roles of renin-angiotensin and endothelin systems in development of diastolic heart failure in hypertensive hearts.Cardiovasc Res,2000,47(2):274-283.
38. Akuzawa N,Nakamura T,Kurashina T,et al.Antihypertensive agents prevent nephrosclerosis and left ventricular hypertrophy induced in rats by prolonged inhibition of nitric oxide synthesis.Am J Hypertens,1998,11(6 Pt 1):697-707.
39. Nagai M,Horikoshi K,Izumi T,et al.Cardioprotective action of perindopril versus candesartan in renovascular hypertensive rats.Cardiovasc Drugs Ther,2004,18(5):353-362.
40. Porteri E,Rodella L,Rizzoni D,et al.Effects of olmesartan and enalapril at low or high doses on cardiac,renal and vascular interstitial matrix in spontaneously hypertensive rats.Blood Press,2005,14(3):184-192.
41. Agarwal V,Briasoulis A,Messerli FH.Effects of renin-angiotensin system blockade on mortality and hospitalization in heart failure with preserved ejection fraction.Heart Fail Rev,2013,18(4):429-437.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of ACEI/ARB for Patients with Diastolic Heart Failure: A Systematic Review

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