Hosam I Taha, Abdalhakim Shubietah, Bashar M Al Zoubi, Mohamed S Elgendy, Hazem Reyad Mansour, Anas Abdulkader, Abdelrahman M Ghazal, Noura Shamis, Mohamed Abuelazm, Mustafa Turkmani, Robert J Mentz
{"title":"急性失代偿性心力衰竭的血管紧张素-萘普利素抑制：随机对照试验的荟萃分析。","authors":"Hosam I Taha, Abdalhakim Shubietah, Bashar M Al Zoubi, Mohamed S Elgendy, Hazem Reyad Mansour, Anas Abdulkader, Abdelrahman M Ghazal, Noura Shamis, Mohamed Abuelazm, Mustafa Turkmani, Robert J Mentz","doi":"10.1080/14796678.2025.2535218","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.</p><p><strong>Methods: </strong>Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.</p><p><strong>Results: </strong>Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; <i>p</i> < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; <i>p</i> = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; <i>p</i> = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; <i>p</i> < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; <i>p</i> = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; <i>p</i> = 0.024).</p><p><strong>Conclusion: </strong>initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.</p><p><strong>Protocol registration: </strong>PROSPERO: CRD42024618027.</p>","PeriodicalId":12589,"journal":{"name":"Future cardiology","volume":" ","pages":"1-13"},"PeriodicalIF":1.0000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Angiotensin-neprilysin inhibition in acute decompensated heart failure: a meta-analysis of randomized controlled trials.\",\"authors\":\"Hosam I Taha, Abdalhakim Shubietah, Bashar M Al Zoubi, Mohamed S Elgendy, Hazem Reyad Mansour, Anas Abdulkader, Abdelrahman M Ghazal, Noura Shamis, Mohamed Abuelazm, Mustafa Turkmani, Robert J Mentz\",\"doi\":\"10.1080/14796678.2025.2535218\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.</p><p><strong>Methods: </strong>Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.</p><p><strong>Results: </strong>Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; <i>p</i> < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; <i>p</i> = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; <i>p</i> = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; <i>p</i> < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; <i>p</i> = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; <i>p</i> = 0.024).</p><p><strong>Conclusion: </strong>initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.</p><p><strong>Protocol registration: </strong>PROSPERO: CRD42024618027.</p>\",\"PeriodicalId\":12589,\"journal\":{\"name\":\"Future cardiology\",\"volume\":\" \",\"pages\":\"1-13\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Future cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/14796678.2025.2535218\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Future cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/14796678.2025.2535218","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Angiotensin-neprilysin inhibition in acute decompensated heart failure: a meta-analysis of randomized controlled trials.
Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.
Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.
Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).
Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.
期刊介绍：
Research advances have contributed to improved outcomes across all specialties, but the rate of advancement in cardiology has been exceptional. Concurrently, the population of patients with cardiac conditions continues to grow and greater public awareness has increased patients" expectations of new drugs and devices. Future Cardiology (ISSN 1479-6678) reflects this new era of cardiology and highlights the new molecular approach to advancing cardiovascular therapy. Coverage will also reflect the major technological advances in bioengineering in cardiology in terms of advanced and robust devices, miniaturization, imaging, system modeling and information management issues.
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