Meta-analysis
Revisiting Race and the Benefit of Renin-angiotensin System (RAS) Blockade in Heart Failure
- Individual-participant data meta-analysis of randomised trials
- 1-stage mixed-effects model
- subgroup analysis by race
Authors' conclusion
The mortality benefit from RAS blockade was similar in Black and non-Black patients. Despite the smaller relative risk reduction in hospitalization for HF with RAS blockade in Black patients, the absolute benefit in Black patients was comparable with non-Black patients because of the greater incidence of this outcome in Black patients.
Study context
- Population
- Adults with heart failure and reduced ejection fraction (HFrEF) in placebo-controlled RAS inhibitor monotherapy trials
- Participants
- 8,825 adults · 3 trials
- Comparison
- RAS blockade vs placebo in Black vs non-Black patients
- Outcome
- First hospitalization for HF or CV death
Pooled result
As reported in the abstract
Further pooled results
First HF hospitalization, Black vs non-Black patients (RAS blockade vs placebo)
- Black patients: HR
- 0.89 (95% CI, 0.70-1.13)
- Non-Black patients: HR
- 0.62 (95% CI, 0.56-0.69)
- P for interaction = .006
CV death, Black vs non-Black patients (RAS blockade vs placebo)
- Black patients: HR
- 0.83 (95% CI, 0.65-1.07)
- Non-Black patients: HR
- 0.84 (95% CI, 0.77-0.93)
- P for interaction = .99
Total HF hospitalizations and CV deaths, Black vs non-Black patients (RAS blockade vs placebo)
- Black patients: rate ratio
- 0.82 (95% CI, 0.66-1.02)
- Non-Black patients: rate ratio
- 0.72 (95% CI, 0.66-0.80)
- P for interaction = .27
Supportive analyses including 2 trials adding an ARB to background ACEi (n = 16 383)
- Consistent findings
Original publication
Summarised from the published abstract; every number is checked against it