COMPARAÇÃO DO USO DE IECA E BRA EM PACIENTES COM INSUFICIÊNCIA CARDÍACA – REVISÃO INTEGRATIVA
Palavras-chave:
Revisão Integrativa; Ensaios Clínicos Randomizados Insuficiência Cardíaca; IECA; BRA.Resumo
Esse estudo comparou a eficácia dos Inibidores da Enzima Conversora de Angiotensina (IECA) e Bloqueadores dos Receptores de Angiotensina, na Insuficiência Cardíaca para os desfechos estabilidade clínica, internações hospitalares e óbitos. Realizou-se buscas de ensaios clínicos randomizados nas bases de dados Cochrane, PubMed e LILACS. Foram coletadas 1.789 referências e 8 foram analisadas na íntegra, totalizando 9.447 pacientes. Os resultados encontrados foram: enalapril reduziu óbitos e internações em doses baixas e alvo; perindopril reduziu hospitalização (HR 0,628; IC 95% 0,408–0,966; P=0,033), mortalidade (HR 0,98; IC (0,63; 1,53) P=0,928) e classe funcional (P 0,030); candesartana reduziu mortalidade e internações recorrentes. Os IECA reduziram o número de óbitos, em percentagem e de acordo com o seguimento terapêutico: 14%(plena), 57%(descontinuação) e 35%(placebo). Assim, os resultados demonstram equivalência terapêutica entre os grupos farmacológicos analisados na IC.
Downloads
Referências
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The lancet. 2012;380(9838):219–29.
Bortolotto L. Importância da proteção cardiovascular durante o tratamento da hipertensão arterial: diferenças entre os agentes inibidores do sistema renina-angiotensina-aldosterona. Rev bras hipertens. 2014;223–31.
Colari FL, Leitão SAT, Faganello LS, Goldraich LA, Clausell N. Insuficiência cardíaca-fisiopatologia atual e implicações terapêuticas. Rev Soc Cardiol Estado de Säo Paulo. 2018;33–41.
Brasil.Ministerio da Saude .Departamento de Informatica do SUS. DATASUS [Internet]. 2020 [Cited 2021 nov 05] Available from: http://datasus.saude. gov.br/.
Oliveira GMM de, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, et al. Estatística Cardiovascular–Brasil 2020. Arquivos brasileiros de Cardiologia. 2020;115:308–439.
Rohde LEP, Montera MW, Bocchi EA, Clausell NO, Albuquerque DC de, Rassi S, et al. Diretriz brasileira de insuficiência cardíaca crônica e aguda. Arquivos Brasileiros de Cardiologia. 2018;111(3):436–539.
Póvoa R, Barroso WS, Brandão AA, Jardim PCV, Barroso O, Passarelli Jr O, et al. I Posicionamento Brasileiro sobre combinação de fármacos anti-hipertensivos. Arquivos Brasileiros de Cardiologia. 2014;102:203–10.
Guyton AC, Hall J. Tratado de Fisiología Médica. T. 2. La Habana: Editorial Ciencias Médicas. 1996;530.
Brunton LL, Hilal-Dandan R, Knollmann BC. As Bases Farmacológicas da Terapêutica de Goodman e Gilman-13. Artmed Editora; 2018.
Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa AD de M, et al. Diretrizes Brasileiras de Hipertensão Arterial–2020. Arquivos Brasileiros de Cardiologia. 2021;116:516–658.
Ferrario, Carlos M et al. “The renin-angiotensin system biomolecular cascade: a 2022 update of newer insights and concepts.” Kidney international supplements vol. 12,1 (2022): 36-47. doi:10.1016/j.kisu.2021.11.002
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. A declaração PRISMA 2020: uma diretriz atualizada para relatar revisões sistemáticas. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
Cochrane. Cochrane Library [Internet]. St Albans House: Wiley. c2000-2019 [cited 2020 Nov 05]. Available from: https://www.cochranelibrary.com.
PubMed. Bethesda: US National Library of Medicine. [cited 2020 Nov 05]. Available from: http://www.pubmed.gov.
Bireme - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde. LILACS: Literatura Latino-americana e do Caribe em Ciências da Saúde [Internet]. São Paulo: BIREME. 2019 [updated 2019 Mar 11; cited 2020 Nov 05]. Available from: http://lilacs.bvsalud.org/.
Health Sciences Descriptors: DeCS [Internet]. 2020 ed. São Paulo (SP): BIREME / PAHO / WHO. 2017 [updated 2017 May 18; cited 2020 Nov 05]. Available from: http://decs.bvsalud.org/I/homepagei.htm.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editores). Cochrane Handbook for Systematic Reviews of Interventions versão 6.3 (atualizado em fevereiro de 2022). Cochrane, 2022. Disponível em www.training.cochrane.org/handbook.
Azevedo ER, Mak S, Floras JS, Parker JD. Acute effects of angiotensin-converting enzyme inhibition versus angiotensin II receptor blockade on cardiac sympathetic activity in patients with heart failure. Am J Physiol Regul Integr Comp Physiol. 2017 Oct 1;313(4):R410-R417. doi: 10.1152/ajpregu.00095.2017. Epub 2017 Jul 5. PMID: 28679681. Beldhuis et al, 2017
Beldhuis IE, Streng KW, Ter Maaten JM, Voors AA, van der Meer P, Rossignol P, McMurray JJ, Damman K. Renin-Angiotensin System Inhibition, Worsening Renal Function, and Outcome in Heart Failure Patients With Reduced and Preserved Ejection Fraction: A Meta-Analysis of Published Study Data. Circ Heart Fail. 2017 Feb;10(2):e003588. doi: 10.1161/CIRCHEARTFAILURE.116.003588. PMID: 28209765. Dass et al, 2020.
Dass B, Dimza M, Singhania G, Schwartz C, George J, Bhatt A, Radhakrishnan N, Bansari A, Bozorgmehri S, Mohandas R. Renin-Angiotensin-Aldosterone System Optimization for Acute Decompensated Heart Failure Patients (ROAD-HF): Rationale and Design. Am J Cardiovasc Drugs. 2020 Aug;20(4):373-380. doi: 10.1007/s40256-019-00389-7. PMID: 31797310.
de Denus S, Dubé MP, Fouodjio R, Huynh T, LeBlanc MH, Lepage S, Sheppard R, Giannetti N, Lavoie J, Mansour A, Provost S, Normand V, Mongrain I, Langlois M, O'Meara E, Ducharme A, Racine N, Guertin MC, Turgeon J, Phillips MS, Rouleau JL, Tardif JC, White M; CANDIID II investigators. A prospective study of the impact of AGTR1 A1166C on the effects of candesartan in patients with heart failure. Pharmacogenomics. 2018 May;19(7):599-612. doi: 10.2217/pgs-2018-0004. Epub 2018 Apr 27. PMID: 29701105.
Khan MS, Fonarow GC, Khan H, Greene SJ, Anker SD, Gheorghiade M, Butler J. Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis. ESC Heart Fail. 2017 Nov;4(4):402-408. doi: 10.1002/ehf2.12204. Epub 2017 Sep 4. PMID: 28869332; PMCID: PMC5695183.
Choi KH, Lee GY, Choi JO, Jeon ES, Lee HY, Cho HJ, Lee SE, Kim MS, Kim JJ, Hwang KK, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Kim KH, Park HY, Cho MC, Oh BH. Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry. Int J Cardiol. 2018 Apr 15;257:168-176. doi: 10.1016/j.ijcard.2017.12.002. PMID: 29506690.
Kızılırmak, Pınar et al. “Renin-angiotensin-aldosterone system blockers and cardiovascular outcomes: a meta-analysis of randomized clinical trials.” Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir vol. 45,1 (2017): 49-66. doi:10.5543/tkda.2016.78006
Ohtsubo T, Shibata R, Kai H, Okamoto R, Kumagai E, Kawano H, Fujiwara A, Kitazono T, Murohara T, Arima H. Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure: a systematic review and meta-analysis. Hypertens Res. 2019 May;42(5):641-649. doi: 10.1038/s41440-018-0167-5. Epub 2019 Apr 5. PMID: 30948834.
Pelayo J, Lo KB, Peterson E, DeFaria C, Nehvi A, Torres R, Maqsood MH, Farooq M, Mathew RO, Rangaswami J. Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers and outcomes in patients with acute decompensated heart failure: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther. 2021 Nov;19(11):1037-1043. doi: 10.1080/14779072.2021.2004121. Epub 2021 Nov 22. PMID: 34751630.
Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effect of renin-angiotensin system inhibition on cardiac structure and function and exercise capacity in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev. 2021 Nov;26(6):1477-1484. doi: 10.1007/s10741-020-09969-1. PMID: 32562021.
Savarese G, Dahlström U, Vasko P, Pitt B, Lund LH. Association between renin-angiotensin system inhibitor use and mortality/morbidity in elderly patients with heart failure with reduced ejection fraction: a prospective propensity score-matched cohort study. Eur Heart J. 2018 Dec 21;39(48):4257-4265. doi: 10.1093/eurheartj/ehy621. PMID: 30351407.
Shimoura H, Tanaka H, Matsumoto K, Mochizuki Y, Hatani Y, Hatazawa K, Matsuzoe H, Ooka J, Sano H, Sawa T, Motoji Y, Ryo-Koriyama K, Hirata KI. Effects of a changeover from other angiotensin II receptor blockers to olmesartan on left ventricular hypertrophy in heart failure patients. Heart Vessels. 2017 May;32(5):584-590. doi: 10.1007/s00380-016-0904-0. Epub 2016 Oct 8. PMID: 27722772.
Tai C, Gan T, Zou L, Sun Y, Zhang Y, Chen W, Li J, Zhang J, Xu Y, Lu H, Xu D. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular events in patients with heart failure: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2017 Oct 5;17(1):257. doi: 10.1186/s12872-017-0686-z. PMID: 28982370; PMCID: PMC5629775.
Yuksek, Umit et al. “The effect of perindopril on echocardiographic parameters, NYHA functional class and serum NT-proBNP values in patients with diastolic heart failure.” Cardiovascular journal of Africa vol. 30,4 (2019): 222-227. doi:10.5830/CVJA-2019-022.
Lam, Phillip H et al. “Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial.” European journal of heart failure vol. 20,2 (2018): 359-369. doi:10.1002/ejhf.937.
Fukuta, Hidekatsu et al. “Effect of renin-angiotensin system inhibitors on mortality in heart failure with preserved ejection fraction: a meta-analysis of observational cohort and randomized controlled studies.” Heart failure reviews vol. 22,6 (2017): 775-782. doi:10.1007/s10741-017-9637-0.
Cleland, John G F et al. “The perindopril in elderly people with chronic heart failure (PEP-CHF) study.” European heart journal vol. 27,19 (2006): 2338-45. doi:10.1093/eurheartj/ehl250.
Massie, Barry M et al. “Irbesartan in patients with heart failure and preserved ejection fraction.” The New England journal of medicine vol. 359,23 (2008): 2456-67. doi:10.1056/NEJMoa0805450.
Yusuf, Salim et al. “Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial.” Lancet (London, England) vol. 362,9386 (2003): 777-81. doi:10.1016/S0140-6736(03)14285-7.
Lund, Lars H et al. “Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum.” European journal of heart failure vol. 20,8 (2018): 1230-1239. doi:10.1002/ejhf.1149.
Darden, Douglas et al. “Implications of renin-angiotensin-system blocker discontinuation in acute decompensated heart failure with systolic dysfunction.” Clinical cardiology vol. 42,10 (2019): 1010-1018. doi:10.1002/clc.23260.
Zheng SL, Chan FT, Nabeebaccus AA, Shah AM, McDonagh T, Okonko DO, Ayis S. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Heart. 2018 Mar;104(5):407-415. doi: 10.1136/heartjnl-2017-311652. Epub 2017 Aug 5. PMID: 28780577; PMCID: PMC5861385.
Lumbers RT, Martin N, Manoharan K, Thomas J, Davies LC. Do beta-blockers and inhibitors of the renin-angiotensin aldosterone system improve outcomes in patients with heart failure and left ventricular ejection fraction >40%? Heart. 2019 Oct;105(20):1533-1535. doi: 10.1136/heartjnl-2018-313855. Epub 2019 Jul 25. PMID: 31345952.
Downloads
Publicado
Edição
Seção
Licença
Os artigos submetidos à revista Colloquium Vitae estão licenciados conforme CC BY-NC-ND. Para mais informações sobre essa forma de Licenciamento, consulte: http://creativecommons.org/licenses/by-nc-nd/4.0/.
A disponibilização é gratuita na Internet, para que os usuários possam ler, fazer download, copiar, distribuir, imprimir, pesquisar ou referenciar o texto integral dos documentos, processá-los para indexação, utilizá-los como dados de entrada de programas para softwares, ou usá-los para qualquer outro propósito legal, sem barreira financeira, legal ou técnica.