Key result
High-dose ACE inhibitors showed a non-significant effect on all-cause mortality compared to low-dose ACE inhibitors in patients with HFrEF (RR 0.95; 95% CI 0.88-1.02).
Why the study?
To compare the effects of low-dose versus high-dose ACE inhibitors on mortality, hospitalisation, functional capacity, and side effects in patients with heart failure.
Does high-dose ACE inhibitors reduce mortality and hospitalizations compared to low-dose ACE inhibitors in adults with HFrEF?
Population
5829 adults with HFrEF across eight RCTs
Comparison
Low-dose vs high-dose ACE inhibitors
Design
Systematic review and random-effects meta-analysis of RCTs
Authors
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High-dose ACE inhibitors confer no mortality benefit over low-dose in HFrEF; challenges routine up-titration and supports individualized dosing trials.
Meta-Analysis (n=5,829)
Does high-dose ACE inhibitors reduce mortality and hospitalizations compared to low-dose ACE inhibitors in adults with HFrEF?
Relative Risk: 0.95 (95% CI 0.88–1.02)
High-dose ACE inhibitors do not significantly reduce mortality or hospitalizations compared to low-dose ACE inhibitors in HFrEF, suggesting the benefit of up-titration may be less than traditionally recommended.
Migliavaca et al. (2020) conducted a meta-analysis in Heart failure with reduced left ventricular ejection fraction (HFrEF) (n=5,829). High-dose ACE inhibitors vs. Low-dose ACE inhibitors was evaluated on All-cause mortality (RR 0.95, 95% CI 0.88-1.02). High-dose ACE inhibitors showed a non-significant effect on all-cause mortality compared to low-dose ACE inhibitors in patients with HFrEF (RR 0.95; 95% CI 0.88-1.02).
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