Abstract

Background

Compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Sacubitril/Valsartan has been reported to have superior results. However, the effects of sacubitril/valsartan on heart failure with preserved ejection fraction (HFpEF) are still in dispute.

Objectives

This study aims to evaluate the effects of sacubitril/valsartan on the treatment of HFpEF patients.

Methods

PubMed, Embase, Web of Science, Cochrane Library, and Clinicaltrials.gov were used to search for randomised controlled trials of sacubitril/valsartan in HFpEF patients from inception to 7 December 2020.

Results

Four studies, with a total of 7739 participants, met the inclusion criteria. The present meta-analysis results showed that compared with the control group, sacubitril/valsartan reduced the hospitalisation rate of HF in HFpEF patients [Risk Ratio(RR): 0.85; 95% confidence interval (CI): 0.79–0.93; p = 0.0002). Regarding all-cause mortality, cardiovascular mortality, and the improvement in NYHA class, sacubitril/valsartan did not show apparent advantages. Although sacubitril/valsartan was linked to increasing the risk of symptomatic hypotension (RR: 1.44; 95% CI: 1.25–1.66; p﹤0.00001), there was no evidence supporting the incidence of renal function worsening and hyperkalemia.

Conclusion

Our study shows that compared with valsartan or individualised medical therapy (IMT), there were not different between the two groups except for the hospitalisation rate which was favoured by Sacubitril/Valsartan treatment group for HFpEF patients.

中文翻译：

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沙库巴曲缬沙坦对射血分数保留型心力衰竭的影响：一项荟萃分析

摘要

背景

据报道，与血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂相比，沙库巴曲/缬沙坦具有更优的效果。然而，沙库巴曲/缬沙坦对射血分数保留的心力衰竭（HFpEF）的影响仍存在争议。

目标

本研究旨在评估沙库巴曲/缬沙坦对 HFpEF 患者治疗的影响。

方法

PubMed、Embase、Web of Science、Cochrane Library 和 Clinicaltrials.gov 用于搜索从开始到 2020 年 12 月 7 日期间沙库巴曲/缬沙坦在 HFpEF 患者中的随机对照试验。

结果

共有 7739 名参与者的四项研究符合纳入标准。目前的荟萃分析结果显示，与对照组相比，沙库巴曲/缬沙坦降低了 HFpEF 患者的 HF 住院率 [风险比 (RR)：0.85；95% 置信区间 (CI)：0.79–0.93；p  = 0.0002）。关于全因死亡率、心血管死亡率和 NYHA 分级的改善，沙库巴曲/缬沙坦没有显示出明显的优势。尽管沙库巴曲/缬沙坦与症状性低血压风险增加有关（RR：1.44；95% CI：1.25–1.66；p ﹤0.00001），但没有证据支持肾功能恶化和高钾血症的发生率。

结论

我们的研究表明，与缬沙坦或个体化药物治疗 (IMT) 相比，除了住院率受到沙库巴曲/缬沙坦治疗组青睐的 HFpEF 患者外，两组之间没有差异。