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Clinical Research in Cardiology

, Volume 108, Issue 11, pp 1240–1248 | Cite as

Angiotensin-converting-enzyme inhibitors in hemodynamic congestion: a meta-analysis of early studies

  • Alexander JobsEmail author
  • Amr Abdin
  • Suzanne de Waha-Thiele
  • Ingo Eitel
  • Holger Thiele
  • Cor de Wit
  • Reinhard Vonthein
Original Paper

Abstract

Aim

Major clinical trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity in congestive heart failure (HF). Prior to these seminal findings hemodynamic effects of ACE inhibitors were examined in small studies. We aimed to review these studies systematically and meta-analyze the effects of ACE inhibitors on hemodynamics in HF.

Methods and results

We identified studies investigating the acute hemodynamic effect of ACE inhibitors in naïve patients with congestive heart failure by searching PubMed and the Cochrane Central Register of Controlled Trials. We extracted the changes in hemodynamic measures and their standard errors from study reports or calculated these values from baseline and post-medication measurements. Data were pooled using random effects models. In total, 41 studies with 46 independent cohorts consisting of 676 patients were included. ACE inhibitor treatment reduced pulmonary capillary wedge pressure by 7.3 (95% confidence interval 6.4–8.2) mmHg and right atrial pressure by 3.7 (95% confidence interval 1.3–6.1) mmHg in patients with HF. Cardiac index increased by 0.4 (95% confidence interval 0.2–0.6) ml/min/m2. Changes in hemodynamic measures were strongly connected to each other in weighted simple linear regression models.

Conclusion

Angiotensin-converting enzyme-inhibitors acutely reduced cardiac filling pressures and increased cardiac output in patients with congestive heart failure who were naïve for these drugs. These data indicate that ACE inhibitors exhibit a strong decongesting effect in congestive heart failure. In light of their impact on long-term prognosis, ACE inhibitors should also be considered as decongesting drugs in stable patients.

Keywords

Heart failure Congestion Hemodynamics Angiotensin-converting-enzyme inhibitors 

Abbreviations

ACE

Angiotensin-converting enzyme

CI

Cardiac index

HF

Heart failure

IPD

Individual patient data

MAP

Mean arterial pressure

PCWP

Pulmonary capillary wedge pressure

RAAS

Renin–angiotensin–aldosterone system

RAP

Right atrial pressure

SVR

Systemic vascular resistance

Notes

Funding

Universitätsklinikum Schleswig–Holstein, Universität zu Lübeck, and Herzzentrum Leipzig.

Compliance with ethical standards

Conflict of interest

No conflict of interest.

Supplementary material

392_2019_1456_MOESM1_ESM.docx (2.7 mb)
Supplementary material 1 (DOCX 2736 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alexander Jobs
    • 1
    • 2
    • 3
    Email author
  • Amr Abdin
    • 4
  • Suzanne de Waha-Thiele
    • 1
    • 2
  • Ingo Eitel
    • 1
    • 2
  • Holger Thiele
    • 3
  • Cor de Wit
    • 2
    • 5
  • Reinhard Vonthein
    • 6
  1. 1.Medizinische Klinik II/Kardiologie, Angiologie, IntensivmedizinUniversitätsklinikum Schleswig-HolsteinLübeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK)LübeckGermany
  3. 3.Klinik für Innere Medizin/KardiologieHerzzentrum Leipzig-UniversitätsklinikLeipzigGermany
  4. 4.Medizinische Klinik I/Kardiologie, Angiologie und internistische IntensivmedizinRWTH AachenAachenGermany
  5. 5.Institut für PhysiologieUniversität zu LübeckLübeckGermany
  6. 6.Institut für Medizinische Biometrie und Statistik, ZKS LübeckUniversität zu LübeckLübeckGermany

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