Heart failure & cardiomyopathiesCohort study
Target Versus Below-Target Dose ACE Inhibitors in U.S. Veterans with Heart Failure with Preserved Ejection Fraction (HFpEF): Differential Outcomes by Chronic Kidney Disease (CKD) Status
- Retrospective cohort study
- propensity-score matched
- outcome-blinded matched cohort
Authors' conclusion
In HFpEF, target-dose ACEIs were associated with a lower risk of KF, a higher risk of HF hospitalization, and no association with mortality. These associations were consistently more favorable in the subgroup with CKD.
Study context
- Population
- US Veterans with HFpEF (EF ≥ 50%) newly initiated on ACE inhibitors, 2000–2018matched cohort n = 61,160
- Participants
- 96,473 veterans
- Exposure
- Target-dose vs below-target-dose ACE inhibitors
- Target-dosen = 30,580
- Outcome
- All-cause mortality, incident kidney failure (KF) and HF hospitalization
- Follow-up
- 5 years
Main finding
As reported in the abstract
All-cause mortality, incident KF, HF hospitalization
Target-dose vs Below-target-doseHazard ratio (95% CI)
KF
0.89(0.83–0.97)
mortality
0.99(0.97–1.02)
HF hospitalization
1.08(1.04–1.12)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| KF, mortality, HF hospitalization in CKD (eGFR 15-59 mL/min/1.73 m²) (subgroup, n = 16,735) — Target-dose vs Below-target-dose · KF | 0.82 (0.75–0.90) | |
| KF, mortality, HF hospitalization in CKD (eGFR 15-59 mL/min/1.73 m²) (subgroup, n = 16,735) — Target-dose vs Below-target-dose · mortality | 0.93 (0.89–0.96) | |
| KF, mortality, HF hospitalization in CKD (eGFR 15-59 mL/min/1.73 m²) (subgroup, n = 16,735) — Target-dose vs Below-target-dose · HF hospitalization | 0.95 (0.90–1.01) | |
| 0.512Hazard ratio (log scale) |
- Kidney failure (KF), mortality, HF hospitalization in CKD (eGFR 15-59 mL/min/1.73 m²) (subgroup, n = 16,735): each association differed significantly from eGFR ≥ 60 mL/min/1.73 m²: interaction p<0.001
Original publication
Target Versus Below-Target Dose ACE Inhibitors in U.S. Veterans with HFpEF: Differential Outcomes by CKD Status. Eur J Heart Fail. Published 30 July 2026. doi:10.1093/ejhf/xuag237
Summarised from the published abstract; every number is checked against it