scholarly journals Is there an antiarrhythmic benefit from switching to sacubitril/valsartan therapy? A systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Anagnostopoulos ◽  
M Kousta ◽  
C Kossyvakis ◽  
E Lakka ◽  
N T Paraskevaidis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Cardiomyopathy ◽  
Angiotensin Receptor Blockers ◽  
Biventricular Pacing ◽  
Meta Analysis ◽  
Cardiac Resynchronization ◽  
Converting Enzyme Inhibitors ◽  
Shock Delivery ◽  
Reduced Ejection Fraction ◽  
Reduced Risk

Abstract Background Sacubitril/valsartan through reverse structural remodeling and neurohormonal inhibition could play an antiarrhythmic role. Purpose This systematic review and meta-analysis was performed to explore the arrhythmiologic effects of switching patients with heart failure with reduced ejection fraction (HFrEF) from angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) to sacubitril/valsartan. Methods We searched major databases for studies comparing device-detected, incident atrial and ventricular arrhythmias in patients with HFrEF while on ACEi/ARBs versus while on sacubitril/valsartan. For pooling the primary outcome of interest, we calculated the risk difference (RD) with the corresponding 95% confidence interval (CI) in the probability of experiencing each arrhythmic event while on ACEi/ARBs and while on sacubitril/valsartan. A random effects (DerSimonian-Laird) model was adopted. Results We analyzed 4 eligible studies, resulting in 497 patients with a pooled mean age of 67.8±10.36. 64% had ischemic cardiomyopathy while 98% had either an implantable cardioverter defribrillator or a cardiac resynchronization therapy device. Main comorbidities were hypertension (68.7%) and dyslipidemia (59.6%). Almost all (96.3%) patients were treated with b-blockers and 23.7% were also receiving anti-arrhythmic drugs, mainly amiodarone. After switching to sacubitril/valsartan there was a trend towards reduced risk for sustained ventricular tachycardia/fibrillation and non-sustained ventricular tachycardias (RD: −0.04, 95% CI: −0.09–0.02, I2: 65.7% and −0.06, 95% CI: −0.19–0.07, I2: 85%; respectively). Meta-regression analysis showed that patients with ischemic cardiomyopathy experience greater benefit. Incident paroxysmal atrial fibrillation/tachycardia was significantly reduced (RD: −0.09 95% CI: −0.14 to −0.03, I2: 0%), while favorable effects were noticed for the risk of appropriate shock delivery and inadequate biventricular pacing (RD: −0.06, 95% CI: −0.09 to −0.03, I2: 0% and −0.06, 95% CI: −0.11 to 0.00, I2: 35.55%, respectively). All results seem to suffer from publication bias. Conclusion Limited data support that switching to sacubitril/valsartan seems to be associated with reduced risk for both ventricular and atrial arrhythmias. More studies are needed to clarify the potential anti-arrhythmic role of this drug. Whether patients with frequent arrhythmias or at high arrhythmic risk may benefit from early switch is a matter of further investigation. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis

2020 ◽  
pp. 039139882095181
Author(s):  
Veraprapas Kittipibul ◽  
Wasawat Vutthikraivit ◽  
Jakrin Kewcharoen ◽  
Pattara Rattanawong ◽  
Pakpoom Tantrachoti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angiotensin Ii ◽  
Gastrointestinal Bleeding ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Converting Enzyme Inhibitors

Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22–0.56, I2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19–1.07, I2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.

scholarly journals Impact of hospitalised patients with COVID-19 taking Renin-Angiotensin-Aldosterone System inhibitors: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Ranu Baral ◽  
Maddie White ◽  
Vassilios S Vassiliou
Keyword(s):  
Systematic Review ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Mortality Data ◽  
Critical Events ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Hospitalised Patients ◽  
The Impact

AbstractInhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a “second wave” of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients.A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with ‘critical’ events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including ‘critical’ events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.

Comparative effectiveness of different antihypertensive agents in kidney transplantation: a systematic review and meta-analysis

2019 ◽  
Vol 35 (5) ◽  
pp. 878-887 ◽  
Author(s):  
Anna Pisano ◽  
Davide Bolignano ◽  
Francesca Mallamaci ◽  
Graziella D’Arrigo ◽  
Jean-Michel Halimi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Transplant ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Graft Loss ◽  
Graft Function ◽  
Antihypertensive Agents ◽  
Kidney Transplant Recipients ◽  
Converting Enzyme Inhibitors ◽  
Risk Of Death

Abstract Background We conducted a systematic review and meta-analysis to compare benefits and harms of different antihypertensive drug classes in kidney transplant recipients, as post-transplant hypertension (HTN) associates with increased cardiovascular (CV) morbidity and mortality. Methods The Ovid-MEDLINE, PubMed and CENTRAL databases were searched for randomized controlled trials (RCTs) comparing all main antihypertensive agents versus placebo/no treatment, routine treatment. Results The search identified 71 RCTs. Calcium channel blockers (CCBs) (26 trials) reduced the risk for graft loss {risk ratio [RR] 0.58 [95% confidence interval (CI) 0.38–0.89]}, increased glomerular filtration rate (GFR) [mean difference (MD) 3.08 mL/min (95% CI 0.38–5.78)] and reduced blood pressure (BP). Angiotensin-converting enzyme inhibitors (ACEIs) (13 trials) reduced the risk for graft loss [RR 0.62 (95% CI 0.40–0.96)] but decreased renal function and increased the risk for hyperkalaemia. Angiotensin receptor blockers (ARBs) (10 trials) did not modify the risk of death, graft loss and non-fatal CV events and increased the risk for hyperkalaemia. When pooling ACEI and ARB data, the risk for graft failure was lower in renin–angiotensin system (RAS) blockade as compared with control treatments. In direct comparison with ACEIs or ARBs (11 trials), CCBs increased GFR [MD 11.07 mL/min (95% CI 6.04–16.09)] and reduced potassium levels but were not more effective in reducing BP. There are few available data on mortality, graft loss and rejection. Very few studies performed comparisons with other active drugs. Conclusions CCBs could be the preferred first-step antihypertensive agents in kidney transplant patients, as they improve graft function and reduce graft loss. No definite patient or graft survival benefits were associated with RAS inhibitor use over conventional treatment.

scholarly journals Association of Renin Angiotensin System Blockers with Outcomes in Patients with Covid-19: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Aakash Garg ◽  
Amit Rout ◽  
Abhishek Sharma ◽  
Brittany Fiorello ◽  
John B. Kostis
Keyword(s):  
Systematic Review ◽  
Critical Illness ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Severe Illness ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk

ABSTRACTBackgroundPatients with cardiovascular disease are at increased risk of critical illness and mortality from Covid-19 disease. Conflicting findings have raised concerns regarding the association of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) use with likelihood or severity of infection during this pandemic.ObjectiveTo study the cumulative evidence for association of ACEI/ARB use with outcomes among patients with confirmed Covid-19.MethodsThe MEDLINE and EMBASE databases were thoroughly searched from November 01, 2019 to May 15, 2020 for studies reporting on outcomes based on ACEI/ARB use in patients with confirmed Covid-19. Preferred reporting items for systematic review and meta-analysis guidelines were used for the present study. Relevant data was collected and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects model.Main Outcome measuresIn-hospital mortality was the primary end of interest. Second end-point was severe or critical illness defined as either need for intensive care unit, invasive mechanical ventilation, or mortality.ResultsFifteen studies with total of 23,822 patients (N ACEI/ARB=6,650) were included in the present analysis. Overall, prevalence of ACEI/ARB use ranged from 7.7% to 46.2% across studies. Among 10 studies, patients using ACEI/ARB had similar odds of mortality [OR 1.03 (0.69-1.55)] and severe or critical illness [1.18 (0.91-1.54)] compared to those not on ACEI/ARB. In an analysis restricted to patients with hypertension, ACEI/ARB use was associated with significantly lower mortality [0.64 (0.45-0.89)], while the odds of severe/critical illness [0.76(0.52-1.12); p=0.16] remained non-significant compared with non-ACEI/ARB users.ConclusionThere is no evidence for increased risk of severe illness or mortality in patients using ACEI/ARB compared with non-users. In patients with hypertension, ACE/ARB use might be associated with reduced mortality, however these findings need to be confirmed in prospective randomized controlled trials.

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