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Additional use of an aldosterone antagonist in patients with mild to moderate chronic heart failure: a systematic review and meta‐analysis
Author(s) -
Hu Lijun,
Chen Yunqing,
Deng Songbai,
Du Jianlin,
She Qiang
Publication year - 2013
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12012
Subject(s) - medicine , heart failure , eplerenone , spironolactone , ejection fraction , cardiology , randomized controlled trial , aldosterone , creatinine , relative risk , meta analysis , confidence interval
Aims Aldosterone antagonists ( A ldo A s) have been used to treat severe chronic heart failure ( CHF ).There is uncertainty regarding the efficacy of using A ldo A s in mild to moderate CHF with N ew Y ork H eart A ssociation ( NYHA ) classifications of I to II . This study summarizes the evidence for the efficacy of spironolactone ( SP ), eplerenone ( EP ) and canrenone in mild to moderate CHF patients. Methods PubMed, MEDLINE , EMBASE and OVID databases were searched before J une 2012 for randomized and quasi‐randomized controlled trials assessing A ldo A treatment in CHF patients with NYHA classes I to II . Data concerning the study's design, patients' characteristics and outcomes were extracted. Risk ratio ( RR ) and weighted mean differences ( WMD ) or standardized mean difference were calculated using either fixed or random effects models. Results Eight trials involving 3929 CHF patients were included. A ldo A s were superior to the control in all cause mortality ( RR 0.79, 95% CI 0.66, 0.95) and in re‐hospitalization for cardiac causes ( RR 0.62, 95% CI 0.52, 0.74), the left ventricular ejection fraction was improved by A ldo A treatment ( WMD 2.94%, P = 0.52). Moreover, A ldo A therapy decreased the left ventricular end‐diastolic volume ( WMD −14.04 ml, P < 0.00001),the left ventricular end‐systolic volume ( WMD −14.09 ml, P < 0.00001). A stratified analysis showed a statistical superiority in the benefits of SP over EP in reducing LVEDV and LVESV . A ldo A s reduced B ‐type natriuretic peptide concentrations ( WMD −37.76 pg ml −1 , P < 0.00001), increased serum creatinine ( WMD 8.69 μmol l −1 , P = 0.0003) and occurrence of hyperkalaemia ( RR 1.78, 95% CI 1.43, 2.23). Conclusions Additional use of A ldo A s in CHF patients may decrease mortality and re‐hospitalization for cardiac reasons, improve cardiac function and simultaneously ameliorate LV reverse remodelling.