Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction (HFpEF)

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction (HFpEF)

• a Cochrane review (41 RCTs, n=23,492) found moderate certainty evidence that mineralocorticoid receptor antagonists (MRA) and angiotensin receptor neprilysin inhibitors (ARNI) may reduce heart failure hospitalisation, but probably have little or no effect on cardiovascular mortality and quality of life
  
  
  • evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life
    
    
  • BB (beta blockers) treatment may reduce the risk of cardiovascular mortality, however, further trials are needed
    
    
  • current evidence for BBs, ACEIs (ACE inhibitors), and ARBs (angiotensin recetptor blockers) is limited and does not support their use in HFpEF in the absence of an alternative indication
    
    
  • Martin et al stated that although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest

A more recent review stated that steroidal MRAs reduce the risk of cardiovascular death or heart failure hospitalisation in patients with HFrEF and non-steroidal MRAs reduce this risk in patients with HFmrEF (heart failure with mildly reduced ejection fraction) or HFpEF (heart failure with reduced ejection fraction).

Reference:

1. Martin N, Manoharan K, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database of Systematic Reviews 2021, Issue 5. Art. No.: CD012721. DOI: 10.1002/14651858.CD012721.pub3
2. Jhund PS et al. Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis. Lancet September 1st 2024.