Why the study?
The prognostic and safety implications of renin-angiotensin-aldosterone system inhibitors in hypertrophic cardiomyopathy were not well established, primarily due to concerns about aggravating LVOT obstruction.
Does the use of renin-angiotensin-aldosterone system inhibitors (RASi) improve or worsen all-cause mortality and heart failure hospitalization in patients with hypertrophic cardiomyopathy?
Does the use of renin-angiotensin-aldosterone system inhibitors (RASi) improve or worsen all-cause mortality and heart failure hospitalization in patients with hypertrophic cardiomyopathy?
In a large real-world cohort of patients with hypertrophic cardiomyopathy, the use of RAS inhibitors was safe and not associated with increased mortality or heart failure hospitalization, even among those with LVOT obstruction.
RASi may be considered if indicated in HCM without apparent harm; leaves open randomized trials to confirm safety and effects.
BACKGROUND AND OBJECTIVES: The prognostic or safety implication of renin-angiotensin-aldosterone system inhibitors (RASi) in hypertrophic cardiomyopathy (HCM) are not well established, mainly due to concerns regarding left ventricular outflow tract (LVOT) obstruction aggravation. We investigated the implications of RASi in a sizable number of HCM patients. METHODS: We enrolled 2,104 consecutive patients diagnosed with HCM in 2 tertiary university hospitals and followed up for five years. RASi use was defined as the administration of RASi after diagnostic confirmation of HCM. The primary and secondary outcomes were all-cause mortality and hospitalization for heart failure (HHF). RESULTS: RASi were prescribed to 762 patients (36.2%). During a median follow-up of 48.1 months, 112 patients (5.3%) died, and 94 patients (4.5%) experienced HHF. Patients using RASi had less favorable baseline characteristics than those not using RASi, such as older age, more frequent history of comorbidities, and lower ejection fraction. Nonetheless, there was no difference in clinical outcomes between patients with and without RASi use (log-rank p=0.368 for all-cause mortality and log-rank p=0.443 for HHF). In multivariable analysis, patients taking RASi showed a comparable risk of all-cause mortality (hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.43-1.14, p=0.150) and HHF (HR, 1.03, 95% CI, 0.63-1.70, p=0.900). In the subgroup analysis, there was no significant interaction of RASi use between subgroups stratified by LVOT obstruction, left ventricular (LV) ejection fraction, or maximal LV wall thickness. CONCLUSIONS: RASi use was not associated with worse clinical outcomes. It might be safely administered in patients with HCM if clinically indicated.
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Park et al. (2023) studied this question.
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