American Journal of Cardiovascular Drugs

, Volume 19, Issue 6, pp 597–605 | Cite as

Safety and Prognostic Impact of Early Treatment with Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients with Acute Heart Failure

  • Kenji Yoshioka
  • Yuya MatsueEmail author
  • Tetsuo Yamaguchi
  • Takeshi Kitai
  • Nobuyuki Kagiyama
  • Takahiro Okumura
  • Keisuke Kida
  • Shogo Oishi
  • Eiichi Akiyama
  • Satoshi Suzuki
  • Masayoshi Yamamoto
  • Shunsuke Kuroda
  • Akihiko Matsumura
  • Kenzo Hirao
Original Research Article



Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been recommended for patients with heart failure, their clinical and prognostic impact in the very acute phase of acute heart failure (AHF) is unclear, mainly because data on their safety and efficacy are lacking.


This study was a post hoc analysis of the REALITY-AHF trial. Patients with AHF who did not take an ACEI or ARB at admission were enrolled. Patients who received these medications within 48 h of admission were categorized as the ACEI/ARB group, and all other patients were categorized as the no ACEI/ARB group. The primary endpoint was a composite of all-cause death and heart failure readmission within 1 year of admission.


Of the 1682 patients in the REALITY-AHF cohort, 900 were enrolled in this study, and 288 (32%) were included in the ACEI/ARB group. After propensity score matching, 152 pairs were evaluated, and no significant difference was found for in-hospital mortality, worsening renal function, or length of hospital stay. The ACEI/ARB group had significantly higher event-free survival (hazard ratio 0.51; 95% confidence interval 0.32–0.82; p = 0.006).


Early initiation of ACEIs/ARBs within 48 h of admission for hospitalized patients with AHF was not associated with adverse events and correlated with improved outcomes at 1 year from admission.


Compliance with Ethical Standards


This study was partly supported by a Grant-in-Aid for Early-Career Scientists (Grant no. 18K15862) and The Cardiovascular Research Fund, Tokyo, Japan.

Conflict of interest

Dr. Yuya Matsue has received an honorarium and grants from Otsuka Pharmaceutical Co. Kenji Yoshioka, Tetsuo Yamaguchi, Takeshi Kitai, Nobuyuki Kagiyama, Takahiro Okumura, Keisuke Kida, Shogo Oishi, Eiichi Akiyama, Satoshi Suzuki, Masayoshi Yamamoto, Shunsuke Kuroda, Akihiko Matsumura, and Kenzo Hirao have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Supplementary material

40256_2019_355_MOESM1_ESM.pdf (345 kb)
Supplementary material 1 (PDF 345 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kenji Yoshioka
    • 1
    • 2
  • Yuya Matsue
    • 3
    • 4
    Email author
  • Tetsuo Yamaguchi
    • 5
  • Takeshi Kitai
    • 6
  • Nobuyuki Kagiyama
    • 7
  • Takahiro Okumura
    • 8
  • Keisuke Kida
    • 9
  • Shogo Oishi
    • 10
  • Eiichi Akiyama
    • 11
  • Satoshi Suzuki
    • 12
  • Masayoshi Yamamoto
    • 13
  • Shunsuke Kuroda
    • 1
    • 2
  • Akihiko Matsumura
    • 1
  • Kenzo Hirao
    • 2
  1. 1.Department of CardiologyKameda Medical CenterChibaJapan
  2. 2.Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Department of Cardiovascular MedicineJuntendo UniversityTokyoJapan
  4. 4.Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
  5. 5.Department of CardiologyJapanese Red Cross Musashino HospitalTokyoJapan
  6. 6.Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
  7. 7.Department of CardiologyThe Sakakibara Heart Institute of OkayamaOkayamaJapan
  8. 8.Department of CardiologyNagoya University School of MedicineNagoyaJapan
  9. 9.Department of PharmacologySt. Marianna University School of MedicineKawasakiJapan
  10. 10.Department of CardiologyHimeji Cardiovascular CenterHimejiJapan
  11. 11.Division of CardiologyYokohama City University Medical CenterYokohamaJapan
  12. 12.Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
  13. 13.Cardiovascular Division, Faculty of MedicineUniversity of TsukubaTsukubaJapan

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