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.	顾东风,黄广勇,何江,等.中国心力衰竭流行病学调查及其患病率.中华心血管病杂志,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.	中华医学会心血管病学分会,《中华心血管病杂志》编辑委员会.慢性心力衰竭诊断治疗指南2007.中华心血管病杂志,2007,35(12):1089-1090.
15.	共识专家组.射血分数正常心力衰竭诊治的中国专家共识.中国医刊,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.	赵林双,向光大,周子华,等.缬沙坦治疗高血压病合并舒张性心功能不全116例.中国新药与临床杂志,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,郑巍,钟新波,等.缬沙坦与卡维地洛治疗左室射血分数正常的心力衰竭临床观察.广东医学,2010,31(17):2302-2304.
25.	陈彩萍,徐承.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭疗效观察.山东医药,2011,51(35):80-81.
26.	何中涵,周炜,陈曼华.贝拉普利与琥珀酸美托洛尔治疗左室射血分数正常的心力衰竭临床观察.临床心血管病杂志,2011,27(9):667-669.
27.	张红颖,甄怀蒙,赵若雷.六分钟步行试验对左室射血分数正常的心力衰竭患者活动耐力评估.中国医师进修杂志,2011,34(31):63-65.
28.	滕景侠.贝拉普利与琥珀酸美托洛尔治疗左室射血分数正常的心力衰竭临床研究.中国当代医药,2012,19(14):72-73.
29.	谢英,段珊瑚,汤惠高.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭疗效研究.中外医疗,2012,31(23):92-94.
30.	陈四喜,王丽娟,燕学波,等.厄贝沙坦对高血压患者左室舒张功能的影响.实用医药杂志,2013,30(7):588-589.
31.	周春丽.替米沙坦联合氨氯地平治疗心力衰竭的疗效.中国药物经济学,2013,(8):242-243.
32.	梁震林.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭的临床研究.当代医学,2014,20(23):141-142.
33.	秦海斌.琥珀酸美托洛尔等药品对左室射血分数正常心力衰竭患者的影响.现代养生,2014,(14):83-83.
34.	尚伶俐,李玉霞,徐贵琴.缬沙坦联合美托洛尔治疗舒张性心力衰竭效果观察.疾病监测与控制杂志,2014,8(6):395-396.
35.	张朝华.厄贝沙坦治疗高血压并射血分数正常的心力衰竭的观察.中国保健营养,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. 顾东风,黄广勇,何江,等.中国心力衰竭流行病学调查及其患病率.中华心血管病杂志,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. 中华医学会心血管病学分会,《中华心血管病杂志》编辑委员会.慢性心力衰竭诊断治疗指南2007.中华心血管病杂志,2007,35(12):1089-1090.
15. 共识专家组.射血分数正常心力衰竭诊治的中国专家共识.中国医刊,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. 赵林双,向光大,周子华,等.缬沙坦治疗高血压病合并舒张性心功能不全116例.中国新药与临床杂志,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,郑巍,钟新波,等.缬沙坦与卡维地洛治疗左室射血分数正常的心力衰竭临床观察.广东医学,2010,31(17):2302-2304.
25. 陈彩萍,徐承.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭疗效观察.山东医药,2011,51(35):80-81.
26. 何中涵,周炜,陈曼华.贝拉普利与琥珀酸美托洛尔治疗左室射血分数正常的心力衰竭临床观察.临床心血管病杂志,2011,27(9):667-669.
27. 张红颖,甄怀蒙,赵若雷.六分钟步行试验对左室射血分数正常的心力衰竭患者活动耐力评估.中国医师进修杂志,2011,34(31):63-65.
28. 滕景侠.贝拉普利与琥珀酸美托洛尔治疗左室射血分数正常的心力衰竭临床研究.中国当代医药,2012,19(14):72-73.
29. 谢英,段珊瑚,汤惠高.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭疗效研究.中外医疗,2012,31(23):92-94.
30. 陈四喜,王丽娟,燕学波,等.厄贝沙坦对高血压患者左室舒张功能的影响.实用医药杂志,2013,30(7):588-589.
31. 周春丽.替米沙坦联合氨氯地平治疗心力衰竭的疗效.中国药物经济学,2013,(8):242-243.
32. 梁震林.替米沙坦联合氨氯地平治疗射血分数正常的心力衰竭的临床研究.当代医学,2014,20(23):141-142.
33. 秦海斌.琥珀酸美托洛尔等药品对左室射血分数正常心力衰竭患者的影响.现代养生,2014,(14):83-83.
34. 尚伶俐,李玉霞,徐贵琴.缬沙坦联合美托洛尔治疗舒张性心力衰竭效果观察.疾病监测与控制杂志,2014,8(6):395-396.
35. 张朝华.厄贝沙坦治疗高血压并射血分数正常的心力衰竭的观察.中国保健营养,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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