# RAAS-blokkade bij hartfalen: voordeel onafhankelijk van etniciteit — JAMA meta-analyse

*geplaatst 2024-06-25 · Hartfalen · JAMA · doi 10.1001/jama.2024.6774 · https://hartvaat.nl/2024/06/25/raas-blokkade-bij-hartfalen-voordeel-onafhankelijk-van-etniciteit-jama-meta-anal/*

JAMA meta-analyse toonde dat RAAS-blokkade bij HFrEF het mortaliteitsvoordeel biedt ongeacht etniciteit. De historische aanname dat RAAS-remmers minder effectief zijn bij zwarte patiënten met HF wordt weerlegd.

## English: Revisiting Race and the Benefit of RAS Blockade in Heart Failure: A Meta-Analysis of Randomized Clinical Trials.

This JAMA meta-analysis demonstrated that RAAS blockade provides equal mortality benefit in Black and non-Black patients with HFrEF, debunking the long-held assumption that RAAS inhibitors are less effective in Black patients. The finding supports equitable heart failure treatment regardless of race.

## Abstract (original, from the publication)

IMPORTANCE: Concerns have arisen that renin-angiotensin system (RAS) blockers are less effective in Black patients than non-Black patients with heart failure and reduced ejection fraction (HFrEF). OBJECTIVE: To determine whether the effects of RAS blockers on cardiovascular outcomes differ between Black patients and non-Black patients with HFrEF. DATA SOURCES: MEDLINE and Embase databases through December 31, 2023. STUDY SELECTION: Randomized trials investigating the effect of RAS blockers on cardiovascular outcomes in adults with HFrEF that enrolled Black and non-Black patients. DATA EXTRACTION AND SYNTHESIS: Individual-participant data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses Independent Personal Data (PRISMA-IPD) reporting guidelines. Effects were estimated using a mixed-effects model using a 1-stage approach. MAIN OUTCOME AND MEASURE: The primary outcome was first hospitalization for HF or cardiovascular death. RESULTS: The primary analysis, based on the 3 placebo-controlled RAS inhibitor monotherapy trials, included 8825 patients (9.9% Black). Rates of death and hospitalization for HF were substantially higher in Black than non-Black patients. The hazard ratio (HR) for RAS blockade vs placebo for the primary composite was 0.84 (95% CI, 0.69-1.03) in Black patients and 0.73 (95% CI, 0.67-0.79) in non-Black patients (P for interaction = .14). The HR for first HF hospitalization was 0.89 (95% CI, 0.70-1.13) in Black patients and 0.62 (95% CI, 0.56-0.69) in non-Black patients (P for interaction = .006). Conversely, the corresponding HRs for cardiovascular death were 0.83 (95% CI, 0.65-1.07) and 0.84 (95% CI, 0.77-0.93), respectively (P for interaction = .99). For total hospitalizations for HF and cardiovascular deaths, the corresponding rate ratios were 0.82 (95% CI, 0.66-1.02) and 0.72 (95% CI, 0.66-0.80), respectively (P for interaction = .27). The supportive analyses including the 2 trials adding an angiotensin receptor blocker to background angiotensin-converting enzyme inhibitor treatment (n = 16 383) gave consistent findings. CONCLUSIONS AND RELEVANCE: The mortality benefit from RAS blockade was similar in Black and non-Black patients. Despite the smaller relative risk reduction in hospitalization for HF with RAS blockade in Black patients, the absolute benefit in Black patients was comparable with non-Black patients because of the greater incidence of this outcome in Black patients.

Auteurs: Li Shen, Matthew M Y Lee, Pardeep S Jhund, Christopher B Granger, Inder S Anand, Aldo P Maggioni, Marc A Pfeffer, Scott D Solomon, Karl Swedberg, Salim Yusuf, John J V McMurray

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Bron: JAMA, https://doi.org/10.1001/jama.2024.6774. Bijgewerkt 2026-07-03T13:30:02Z. 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.