Higher versus lower doses of ACE inhibitors, angiotensin-2 receptor blockers and beta-blockers in heart failure with reduced ejection fraction: Systematic review and meta-analysis

PloS One
Ricky D TurgeonJames P McCormack

Abstract

Current heart failure (HF) guidelines recommend titrating angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and beta-blockers (BBs) to target doses used in pivotal placebo-controlled randomized controlled trials (RCTs). Despite a number of RCTs comparing different doses (i.e. higher versus lower doses) of ACEIs, ARBs and BBs, the effects of higher versus lower doses on efficacy and safety remains unclear. For this reason, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of higher versus lower doses of ACEIs, ARBs and BBs in patients with HFrEF. We searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) via Ovid from inception to April 25th, 2018 and opentrials.net and clinicaltrials.gov for relevant trials that compared different doses of medications in heart failure. We analyzed trials by drug class (ACEIs, ARBs, and BBs) for efficacy outcomes (all-cause mortality, cardiovascular mortality, all-cause hospitalizations, HF hospitalizations, HF worsening). For safety outcomes, we pooled trials within and across drug classes. Our meta-analysis consisted of 14 RCTs. Using GRADE criteria, the quality of evidence for ACEIs and ...Continue Reading

References

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Citations

Jun 21, 2019·British Journal of Clinical Pharmacology·Hans G StampferSimon B Dimmitt
Jun 21, 2019·British Journal of Clinical Pharmacology·Simon B DimmittRobin E Ferner
May 8, 2020·Kardiologiia·O N TkachevaG S Krasnov
May 7, 2020·Circulation. Heart Failure·Jesse F VeenisUNKNOWN CHECK-HF Investigators
Nov 27, 2019·European Journal of Heart Failure·Finlay A McAlisterPaul W Armstrong
Jun 17, 2020·Frontiers in Pharmacology·Yili ZhangYong Wang
Oct 19, 2020·European Journal of Clinical Pharmacology·Sylvaine Bœuf-GibotHélène Vaillant-Roussel
Oct 25, 2020·Heart Failure Reviews·Dimitrios SfairopoulosPanagiotis Korantzopoulos
Jan 17, 2021·The Canadian Journal of Cardiology·Robert J H MillerNowell M Fine
Feb 17, 2021·Diabetes & Vascular Disease Research : Official Journal of the International Society of Diabetes and Vascular Disease·Jessica KearneyMark T Kearney
May 27, 2021·The Journal of Bone and Joint Surgery. American Volume·Eric H TischlerMatthew S Austin

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