Heart failure & cardiomyopathiesCohort study
Target-dose vs below-target-dose ACE inhibitors and lower risk of kidney failure and mortality in US Veterans with heart failure with reduced ejection fraction (HFrEF)
- Retrospective cohort study
- propensity-score matched
Authors' conclusion
In patients with HFrEF, target-dose (vs. below-target-dose) ACEIs, but not ARBs, were associated with lower risk of KF, which was significant in those with advanced CKD. The survival benefit was modest and limited to those without advanced CKD.
Study context
- Population
- US Veterans with HFrEF (EF≤40%) and no baseline kidney failure initiated on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 2000–2018matched cohorts N=70,860 ACEI, N=7900 ARB
- Participants
- 154,945 veterans
- Exposure
- Target-dose vs below-target-dose ACEIs and ARBs
- Target-dose ACEIn = 35,430
- Target-dose ARBn = 3,950
- Outcome
- Kidney failure (KF) and all-cause mortality
- Follow-up
- 5 years
Main finding
As reported in the abstract
Target-dose ACEI vs Below-target-dose ACEIHazard ratio (95% CI)
KF
0.82(0.75–0.89)
all-cause death
0.94(0.92–0.97)
Observational data: associations, not effects.
Further findings
Kidney failure (KF) and mortality by baseline eGFR, ACEI cohort (subgroup)
- KF association significant with baseline eGFR <35 ml/min/1.73m2
- Mortality association significant with eGFR ≥35 ml/min/1.73m2
Original publication
Target-dose vs below-target-dose ACE inhibitors and lower risk of kidney failure and mortality in US Veterans with HFrEF. Eur J Heart Fail. Published 9 March 2026. doi:10.1093/ejhf/xuag076
Summarised from the published abstract; every number is checked against it