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Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: a meta-analysis.
- Source :
-
European Journal of Heart Failure . Oct2016, Vol. 18 Issue 10, p1238-1243. 6p. - Publication Year :
- 2016
-
Abstract
- <bold>Aims: </bold>The combined neprilysin/renin-angiotensin system (RAS) inhibitor sacubitril/valsartan reduced cardiovascular death or heart failure hospitalization, cardiovascular death, and all-cause mortality in a large outcomes trial. While sacubitril/valsartan is the only currently available drug in its class, there are two prior clinical trials in heart failure with omapatrilat, another combined neprilysin/RAS inhibitor. Using all available evidence can inform clinicians and policy-makers.<bold>Methods and Results: </bold>We performed a meta-analysis using data from three trials in heart failure with reduced EF that compared combined neprilysin/RAS inhibition with RAS inhibition alone and reported clinical outcomes: IMPRESS (n = 573), OVERTURE (n = 5770), and PARADIGM-HF (n = 8399). We assessed the pooled hazard ratio (HR) for all-cause death or heart failure hospitalization, and for all-cause mortality in random-effects models, comparing combined neprilysin/RAS inhibition with ACE inhibition alone. The composite outcome of death or heart failure hospitalization was reduced numerically in patients receiving combined neprilysin/RAS inhibition in all three trials, with a pooled HR of 0.86, 95% confidence interval (CI) 0.76-0.97, P = 0.013. For the endpoint of all-cause mortality, the pooled HR was 0.88, 95% CI 0.80-0.98, P = 0.021. Combined neprilysin/RAS inhibition compared with ACE inhibition was associated with more hypotension, but less renal dysfunction and hyperkalaemia in all three trials.<bold>Conclusions: </bold>Pooled estimates from three trials with two separate drugs of combined neprilysin/RAS inhibition support the use of combined neprilysin/RAS inhibition in heart failure with reduced EF. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HEART failure treatment
*NEPRILYSIN
*RENIN-angiotensin system
*COMBINATION drug therapy
*VANLEV (Drug)
*META-analysis
*AMINOBUTYRIC acid
*COMPARATIVE studies
*HEART failure
*HETEROCYCLIC compounds
*RESEARCH methodology
*MEDICAL cooperation
*PROTEOLYTIC enzymes
*RESEARCH
*SYSTEMATIC reviews
*EVALUATION research
*ANGIOTENSIN receptors
*STROKE volume (Cardiac output)
*PHYSIOLOGY
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 18
- Issue :
- 10
- Database :
- Academic Search Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 118527553
- Full Text :
- https://doi.org/10.1002/ejhf.603