Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: a meta-analysis
Combined neprilysin and renin-angiotensin system inhibition in heart failure with reduced ejection fraction: a meta-analysis
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DOI：
10.1002/ejhf.603
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发表时间：
2016-10-01
影响因子：
18.2
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Solomon, Scott D.;Claggett, Brian;Fonarow, Gregg C.
目的在一项大型结局试验中，联合使用脑啡肽酶/肾素-血管紧张素系统（RAS）抑制剂沙库巴曲/缬沙坦可降低心血管死亡或心力衰竭住院、心血管死亡和全因死亡率。虽然沙库巴曲/缬沙坦是目前唯一可用的同类药物，但有两项关于另一种联合脑啡肽酶/RAS抑制剂omapatrilat的心力衰竭临床试验。使用所有可用的证据可以通知临床医生和policy-makers.Methods和resultsWe进行了荟萃分析，使用三个试验的数据在心力衰竭EF降低，比较合并脑啡肽酶/RAS抑制与RAS抑制单独和报告的临床结果：IMPRESS（n = 573），OVERTURE（n = 5770），PARADIGM-HF（n = 8399）。我们评估了全因死亡或心力衰竭住院以及随机效应模型中全因死亡率的汇总风险比（HR），将脑啡肽溶酶/RAS联合抑制与单独ACE抑制进行比较。在所有三项试验中，接受脑啡肽酶/RAS联合抑制的患者死亡或心力衰竭住院治疗的复合结局在数值上减少，合并HR为0.86，95%置信区间（CI）为0.76-0.97，P = 0.013。对于全因死亡终点，汇总HR为0.88，95% CI 0.80-0.98，P = 0.021。联合neprilysin/RAS抑制与ACE抑制相比，与更多的低血压，但较少肾功能不全和高钾血症在所有three trials.ConclusionsPooled估计从三个试验与两个单独的药物联合neprilysin/RAS抑制支持使用联合neprilysin/RAS抑制在心力衰竭EF降低。
AimsThe 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.Methods and resultsWe 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.ConclusionsPooled 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.