Abstract 16432: Optimal Dosing of ACE Inhibitors and ARBs in Chronic Heart Failure Patients - A Meta-analysis of Randomized Controlled Trials
Introduction: Congestive heart failure (CHF) is associated with significant morbidity and mortality. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are proven to be beneficial for improved survival and better quality of life in Heart failure patients. Optimal dosing of these agents presents a challenging question till date and controversy still surrounds whether similar health benefits can be achieved through lower dosages of ACE inhibitors and ARBs. Our aim was to determine whether there is a significant mortality benefit in CHF patients who receive higher dosage of ACE inhibitors and ARBs compared to lower dosage.
Methods: Medline Indexed and Non-indexed, Cochrane Central, CINAHL and PsychINFO were searched for randomized controlled trials (RCTs) published till date. All RCTs that compared the clinical impact of high versus low dosage of ACE inhibitors or ARBs in heart failure patients were identified. Two independent investigators assessed the studies against an a priori inclusion criteria and disagreements were resolved by mutual discussion.
Results: We used reported event rates for all studies to compute cumulative odds ratio and p-value for mortality. Summary effects were estimated using random effects models in RevMan 5.2. Of 1610 potentially relevant studies, a total of 5 studies (9027 patients) met our inclusion criteria and had data available on mortality events. The pooled estimate of the included studies showed a statistically significant 10% reduction in mortality of CHF patients who received higher dosage of ACE inhibitor and ARBs. (Odds Ratio: 0.90; 95% confidence interval 0.82,0.99). Heterogeneity was tested and it showed no evidence of publication bias.
Conclusions: In conclusion, our meta-analysis of RCTs shows that higher dosage of ACE inhibitors and ARBs have a clinically and statistically significant mortality benefit over lower dosage in the management of chronic heart failure patients.
Author Disclosures: A.H. Malik: None. Y. Akram: None. S.S. Malik: None.
- © 2015 by American Heart Association, Inc.