Safety and Efficacy of Anti-Hypertensive Medications in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-analysis.

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE High Blood Pressure & Cardiovascular Prevention Pub Date : 2024-05-01 Epub Date: 2024-05-13 DOI:10.1007/s40292-024-00646-0

Mohammed Al-Sadawi, Michael Tao, Simrat Dhaliwal, Mark Goldschmit, Edlira Tam, Noel Mann

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Abstract

Introduction: Hypertension (HTN) is a co-morbidity that is commonly associated with heart failure with preserved ejection fraction (HFpEF). However, it remains unclear whether treatment of hypertension in HFpEF patients is associated with improved cardiovascular outcomes.

Aim: The purpose of this meta-analysis is to evaluate the association of anti-hypertensive medical therapy with cardiovascular outcomes in patients with HFpEF.

Methods: We performed a database search for studies reporting on the association of anti-hypertensive medications with cardiovascular outcomes and safety endpoints in patients with HFpEF. The databases searched include OVID Medline, Web of Science, and Embase. The primary endpoint was all-cause mortality. Secondary endpoints include cardiovascular (CV) mortality, worsening heart failure (HF), CV hospitalization, composite major adverse cardiovascular events (MACE), hyperkalemia, worsening renal function, and hypotension.

Results: A total of 12 studies with 14062 HFpEF participants (7010 treated with medical therapy versus 7052 treated with placebo) met inclusion criteria. Use of anti-hypertensive medications was not associated with lower all-cause mortality, CV mortality or CV hospitalization compared to treatment with placebo (OR 1.02, 95% CI 0.77-1.35; p = 0.9, OR 0.88, 95% CI 0.73-1.06; p = 0.19, OR 0.99, 95% CI 0.87-1.12; p = 0.83, OR 0.90, 95% CI 0.79-1.03; p = 0.11). Anti-hypertensive medications were not associated with lower risk of subsequent acute myocardial infarction (AMI) (OR 0.53, 95% CI 0.07-3.73; p = 0.5). Use of anti-hypertensive medications was associated with a statistically significant lower risk of MACE (OR 0.90, 95% CI 0.83-0.98; p = 0.02).

Conclusions: While treatment with anti-hypertensive medications was not associated with lower risk of all-cause mortality, their use may be associated with reduce risk of adverse cardiovascular outcomes in patients with HFpEF regardless of whether they have HTN. Additional high quality studies are required to clarify this association and determine the effect based on specific classes of medications.

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射血分数保留型心力衰竭患者服用抗高血压药物的安全性和有效性：系统回顾与元分析》。

简介高血压（HTN）是射血分数保留型心力衰竭（HFpEF）的常见并发症。目的：本荟萃分析旨在评估抗高血压药物治疗与 HFpEF 患者心血管预后的关系：我们在数据库中搜索了有关高血压药物治疗与 HFpEF 患者心血管预后和安全终点相关性的研究报告。检索的数据库包括 OVID Medline、Web of Science 和 Embase。主要终点是全因死亡率。次要终点包括心血管（CV）死亡率、心衰（HF）恶化、CV住院、复合主要不良心血管事件（MACE）、高钾血症、肾功能恶化和低血压：共有 12 项研究的 14062 名 HFpEF 参与者（7010 人接受药物治疗，7052 人接受安慰剂治疗）符合纳入标准。与安慰剂治疗相比，使用抗高血压药物与降低全因死亡率、冠心病死亡率或冠心病住院率无关（OR 1.02，95% CI 0.77-1.35；P = 0.9，OR 0.88，95% CI 0.73-1.06；P = 0.19，OR 0.99，95% CI 0.87-1.12；P = 0.83，OR 0.90，95% CI 0.79-1.03；P = 0.11）。抗高血压药物与继发急性心肌梗死（AMI）的风险降低无关（OR 0.53，95% CI 0.07-3.73；P = 0.5）。使用抗高血压药物与MACE风险显著降低有关（OR 0.90，95% CI 0.83-0.98；P = 0.02）：虽然抗高血压药物治疗与降低全因死亡风险无关，但无论是否患有高血压，使用抗高血压药物可能与降低高房颤患者不良心血管结局的风险有关。需要进行更多高质量的研究来澄清这种关联，并确定特定药物类别的效果。

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来源期刊

High Blood Pressure & Cardiovascular Prevention PERIPHERAL VASCULAR DISEASE-

CiteScore

5.70

自引率

3.30%

发文量

期刊介绍： High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes: Invited ''State of the Art'' reviews. Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.