Meta-Analysis Of The Effect Of Sacubitril Valsartan On Patients With Heart Failure With Preserved Ejection Fraction

Objective:A randomized controlled trial(RCT)of sacubitril-valsartan(S-V)in patients with heart failure with preserved ejection fraction(HFp EF)was conducted to systematically evaluate the effects of S-V on patients with HFp EF.A randomized controlled trial(RCT)was conducted to systematically evaluate the effect of S-V on patients with HFp EF and to provide a basis for clinical pharmacological treatment of patients with HFp EF.Methods:A comprehensive search for RCTs of S-V for HFp EF was conducted using Chinese and English databases such as Wanfang,China Knowledge Network,China Biomedical Literature,Vipshop Chinese Science and Technology Journal,Pub Med,Embase,Web of Science,The Cochrane Library,etc.The search period was from the date of database creation to June30,2022.The literature was screened strictly according to the inclusion and exclusion criteria,the quality of the included literature was objectively evaluated,and the literature data were extracted precisely and analysed using Review Manager 5.4 software.Results:A total of 20 studies with a total of 9377 patients were included.The results of this study showed that compared with the control group,the experimental group could significantly reduce the rehospitalization rate of heart failure in HFp EF patients [RR=0.55,95%CI(0.41,0.74),P < 0.0001]and the level of NT-pro BNP after treatment [SMD=-3.04,95%CI(-3.86,-2.23).P < 0.0001],significantly improved NYHA cardiac function grade[RR=1.15,95%CI(1.09,1.23),P < 0.0001] and ventricular diastolic function(E/A)[SMD=0.57,95%CI(0.32,0.82),P < 0.0001],Improved exercise tolerance for 6-minute walking distance [SMD=2.03,95%CI(1.17,2.90),P < 0.0001] and left ventricular ejection fraction [SMD=0.49,95%CI(0.14,0.85),P=0.007],but increased cardiovascular mortality [RR=0.72,There was no significant advantage in 95%CI(0.43,1.19),P=0.19] and all-cause mortality [RR=0.98,95%CI(0.85,1.11),P=0.72].There was no significant difference between the experimental group and the control group in total adverse drug reactions [RR=0.99,95%CI(0.93,1.05),P=0.63],high blood potassium [RR=0.87,95%CI(0.76,1.00),P=0.05] and dry cough[RR=0.50,95%CI(0.13,1.97),P=0.32],but the trial group significantly reduced the risk of renal insufficiency [RR=0.78,95%CI(0.68,0.91),P=0.001] and significantly increased hypotension [RR=1.42,95%CI(1.24,1.63).P < 0.0001] and angioedema [RR=2.27,95%CI(1.06,4.84),P=0.03].Conclusions:The results of this study showed that S-V significantly improved heart failure readmission rates,NT-pro BNP,NYHA cardiac function class,E/A,LVEF,and 6MWD in patients with HFp EF compared to ACEI/ARB-based anti-heart failure drugs,but did not show significant advantages in terms of cardiovascular mortality,all-cause mortality,and total adverse drug reactions.