Objective To evaluate the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) on the left ventricular texture parameters, blood kinetics parameters, degree of cardiac function and rate of side effects of patients with heart failure when compared to angiotensin receptor blocker (ARB). Methods We searched MEDLINE (1966 to 2004), EMBASE (1989 to 2000), The Cochrane Library (Issue 1, 2004), IPA (1970 to 2004), and Chinese Biomedicine Database (1980 to 2003). The quality of included studies such as randomization, blinding, allocation concealment and loss of follow up was evaluated and meta-analysis was performd by RevMan 4.2 software. Results Eighteen randomized controlled trials (RCTs) were included. The meta-analysis of efficacy didn’t show statistical significance when comparing the pooled effect size of left ventricular end-diastolic diameter (LVEDD), cardiac output (CO), heart rate (HR), degree of cardiac function. The pooled RR rate of side effects was 2.17, 95%CI 1.53 to 3.07, P＜0.000 01. Conclusions No evidence shows significant difference of ACEI group from ARB group in the improvement of cardiac function and left ventricle remodeling. The rate of side effects of ACEI is statistically higher than that of ARB.
ObjectiveTo systematically review the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) in the treatment of patients with diastolic heart failure (DHF). MethodsPubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data, VIP and CBM were electronically searched from inception to November 2014 for randomized controlled trials (RCTs) of ACEI/ARB for DHF patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 22 RCTs involving 9 557 patients were included. The results of meta-analysis indicated that, compared with the control group, the ACEI/ARB group had significant improvements in exercise capacity (6-minute walk distance:SMD=0.02, 95% CI 0.05 to 0.38, P=0.01; Exercise time:MD=40.58, 95% CI 14.06 to 67.10, P=0.003) and diastolic function (E/A ratio:MD=0.20, 95% CI 0.09 to 0.31, P=0.000 4; E/E' ratio:MD=-1.69, 95% CI -2.11 to -1.27, P<0.000 01). In addition, compared with the control treatment, ACEI/ARB could significantly decrease the serum BNP level (SMD=-0.44, 95% CI -0.72 to -0.16, P=0.002) and NT-proBNP level (SMD=-0.68, 95% CI -1.24 to -0.12, P=0.02). ConclusionCurrent evidence shows that ACEI/ARB can improve the exercise capacity and diastolic function, and reduce the levels of serum BNP and NT-proBNP in DHF patients. Due to the limited quality of the included studies and discrepancies in the diagnostic criteria of DHF, more high-quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy of different rennin-angiotensin system blockers in prevention of stroke recurrence and reduction of major vascular events in patients with prior stroke.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of ACEIs and ARBs for stroke secondary prevention from inception to November 1st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using Stata 15.1 software.ResultsA total of 6 RCTs involving 25 620 patients were included. The results of network meta-analysis showed that: in prevention of stroke recurrence, candesartan (RR=0.40, 95%CI 0.16 to 0.99) and valsartan (RR=0.22, 95%CI 0.07 to 0.76) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.24, 95%CI 0.07 to 0.81), ramipril (RR=0.26, 95%CI 0.07 to 0.93) and perindopril (RR=0.23, 95%CI 0.07 to 0.81). For reducing the major vascular events after stroke, candesartan (RR=0.39, 95%CI 0.21 to 0.74), valsartan (RR=0.27, 95%CI 0.11 to 0.64) and ramipril (RR=0.76, 95%CI 0.60 to 0.95) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.29, 95%CI 0.12 to 0.69), ramipril (RR=0.36, 95%CI 0.15 to 0.88) and perindopril (RR=0.28, 95%CI 0.12 to 0.68); candesartan was lower than telmisartan (RR=0.42, 95%CI 0.22 to 0.79) and perindopril (RR=0.41, 95%CI 0.21 to 0.79).ConclusionsCurrent evidence shows that valsartan and candesartan can reduce the stroke recurrence and major vascular events after stroke. Ramipril can reduce the major vascular event in patients with prior stroke. Valsartan might be the best option in both outcomes. Due to limited quantity of the included studies, more high quality studies are required to verify above conclusions.