Meta-analysis
Short-term effects of combinations of heart failure therapies on blood pressure, kidney function and serum potassium
- Pooled individual participant-level analysis of randomised trials
- prediction model
- 9 RCTs
Authors' conclusion
These analyses provide individualized estimates of the expected treatment effect for any combination of medical therapies in HFrEF and HFmrEF/HFpEF on BP, kidney function and serum potassium.
Study context
- Population
- Patients with HF in trials of ARNI, steroidal MRA, nonsteroidal MRA and SGLT2 inhibitors
- Participants
- 38,753 patients · 9 RCTs
- Comparison
- Heart failure with reduced ejection fraction (HFrEF) vs HFmrEF/HFpEF
- HFrEFn = 16,877
- HFmrEF/HFpEFn = 21,876
- Outcome
- Short-term treatment effects of combination therapy on systolic blood pressure (SBP), DBP, estimated glomerular filtration rate (eGFR) and serum potassium
- Follow-up
- 2-12 weeks
Pooled result
As reported in the abstract
SBP
Estimated mean treatment effect, mmHg
- ARNI + SGLT2i + steroidal mineralocorticoid receptor antagonist (sMRA) (HFrEF)
- −9.2 (95% CI −10.6 to −7.8)
- SGLT2i + sMRA (HFmrEF/HFpEF)
- −5.9 (95% CI −7.3 to −4.6)
- SGLT2i + nonsteroidal MRA (nsMRA) (HFmrEF/HFpEF)
- −4.8 (95% CI −5.7 to −4.0)
Further pooled results
| Outcome | Estimate |
|---|---|
| eGFR — ARNI + SGLT2i + sMRA (HFrEF) · 95% PI | estimated treatment effect −6.8 ml min-1 m-2 (95% CI −7.9 to −5.4) |
| eGFR — SGLT2i + sMRA (HFmrEF/HFpEF) · 95% PI | treatment effect −7.7 ml min-1 m-2 (95% CI −8.9 to −6.4) |
| eGFR — SGLT2i + nsMRA (HFmrEF/HFpEF) · 95% PI | treatment effect −6.1 ml min-1 m-2 (95% CI −6.7 to −5.5) |
| Serum potassium — ARNI + SGLT2i + sMRA (HFrEF) · 95% PI | estimated treatment effect +0.30 mmol l-1 (95% CI 0.25–0.35) |
| Serum potassium — SGLT2i + sMRA (HFmrEF/HFpEF) · 95% PI | treatment effect +0.34 mmol l-1 (95% CI 0.29–0.38) |
| Serum potassium — SGLT2i + nsMRA (HFmrEF/HFpEF) · 95% PI | treatment effect +0.21 mmol l-1 (95% CI 0.18–0.25) |
Original publication
Short-term effects of combinations of heart failure therapies on blood pressure, kidney function and serum potassium. Nat Med. Published 31 August 2026. doi:10.1038/s41591-026-04623-z
Summarised from the published abstract; every number is checked against it