Author + information
- Saurabh Aggarwal,
- Rohit Loomba,
- Nawfal Al-Khafaji,
- Gaurav Aggarwal,
- Venkata Alla and
- Rohit Arora
Background: Recent publication of ATMOSPHERE (Aliskerin, Enalapril or Aliskerin and Enalapril in Heart Failure) trial has fueled the interest in improving the signs and symptoms of heart failure by blocking the renin-angiotensin system (RAS) at more than one site in patients with heart failure.
Methods: We searched PubMed, EMBASE and Cochrane for publications comparing a combination therapy to block RAS versus single drug therapy in patients with heart failure. Combination therapy may include ACE (angiotensin converting enzyme) inhibitor with an ARB (angiotensin receptor blocker), ACE inhibitor with aliskerin or ARB with aliskerin.
Results: A total of 8 randomized controlled trials were included. Compared to treatment with a single RAS blocker, patients with heart failure who were on dual RAS blockade therapy had significantly decreased rate of primary outcome of combined cardiovascular death or hospitalization (Odds ratio (OR) 0.90, 95% confidence interval (CI) 0.82-0.99, p=0.03), driven primarily by decrease in repeat hospitalizations (OR 0.78, 95% CI 0.65-0.94, p=0.007). However, there was an increased incidence of AKI (OR 1.68, 95% CI 1.23-2.28, p=0.001), hyperkalemia (OR 2.22, 95% CI 1.37-3.59, p=0.001) and hypotension (OR 1.56, 95% CI 1.4-1.73, p<0.00001) with the combination therapy.
Conclusions: In patients with heart failure, sequential RAS blockade was associated with a decrease in repeat hospitalizations but at expense of increased risk of acute kidney injury and hypotension.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Heart Failure Is Just a Revolving Door
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1293-251
- 2017 American College of Cardiology Foundation