{"id":"605c86415d0f","type":"article","url":"https://hartvaat.nl/2017/11/01/raas-blokkade-bij-hfpef-systematische-review-en-meta-analyse/","title":"RAAS-blokkade bij HFpEF: systematische review en meta-analyse","title_en":"Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","hfref","ras-remmers","sacubitril-valsartan","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12204","source_url":"https://doi.org/10.1002/ehf2.12204","authors":["Muhammad Shahzeb Khan","Gregg C Fonarow","Hassan Khan","Stephen J Greene","Stefan D Anker","Mihai Gheorghiade","Javed Butler"],"significance":7,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This meta-analysis of renin-angiotensin blockade in HFpEF found modest reductions in heart failure hospitalization but no mortality benefit with ACE inhibitors or ARBs. The analysis highlighted the limited efficacy of conventional neurohormonal therapy in preserved ejection fraction.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar het effect van renine-angiotensine blokkade bij hartfalen met behouden ejectiefractie. Ondanks breed gebruik is het bewijs beperkt.","abstract_original":"Studies with angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in patients with heart failure with preserved ejection fraction (HFpEF) have yielded inconsistent results. To conduct a systematic review and meta-analysis of all evidence for ACE-I and ARBs in patients with HFpEF, we searched PubMed, Ovid SP, Embase, and Cochrane database to identify randomized trials and observational studies that compared ACE-I or ARBs against placebo or standard therapy in HFpEF patients. Random-effect models were used to pool the data, and I2 testing was performed to assess the heterogeneity of the included studies. A total of 13 studies (treatment arm = 8676 and control arm = 8608) were analysed. Pooled analysis of randomized trials for ACE-I and ARBs (n = 6) did not show any effect on all-cause mortality [relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.93-1.11, P = 0.68, I2  = 0%], while results from observational studies showed a significant improvement (RR = 0.91, 95% CI = 0.87-0.95, P = 0.005, I2  = 81.5%). In pooled analyses of all studies, ACE-I showed a reduction of all-cause mortality (RR = 0.91, 95% CI = 0.87-0.95, P = 0.01). There was no reduction in cardiovascular mortality seen, but in pooled analysis of randomized trials, there was a trend towards reduced HF hospitalization risk (RR = 0.91, 95% CI = 0.83-1.01, I2  = 0%, P = 0.074). These data suggest that ACE-I and ARBs may have a role in improving outcomes of patients with HFpEF, underscoring the need for future research with careful patient selection, and trial design and conduct."}