Meta-analysis Of The Therapeutic Effect Of RAAS Blockers On The Prognosis Of Patients With Hypertrophic Cardiomyopathy

Objective: Systematic analyze the efficacy and safety of RAAS blockers for hypertrophic cardiomyopathy patients.Methods: We conducted a systematic computerized literature of the databases of Pub Med,Web of Science,EMBASE and China Knowledge Network(CNKI),Wangfang Database,Weipu Database.We obtained all the documents from the earliest records to January 2020.The search direction was a clinically randomized controlled trial(RCT)that comparing ACEI/ARB/aldosterone receptor antagonists in hypertrophic cardiomyopathy patients compared to placebo or conventional treatment.The process of including and excluding screening documents was conducted by two researchers in accordance with the established standards.If there were differences in the process,consensus was reached through discussion or the third researcher assisted in the judgment.A meta-analysis was conducted on the outcomes of the included trials with the assistance of Rev Man 5.3 software.The main effect indicators evaluated were left ventricular mass,left ventricle wall thickness,left vent ventricular ejection fraction,and E/e’,NT-pro BNP,PINP,PIIINP.Results: Finally,a total of 10 randomized controlled trails involving a total of 392 patients were included in the study.The average follow-up time for each study was about1 year.The results of the analysis of 10 studies are as follows:(1)LVEF:3 observational studies were included,no significant difference was found[WMD=1.74,95%CI(-0.92～4.41),p=0.2];(2)LV mass change:5 observational studies were included,no significant difference was found [SMD=0.03,95%CI(-0.58～0.63),p=0.94];(3)LV wall thickness change:5 observational studies were included,no significant difference was found[SMD=-0.04,95%CI(-0.27～0.19),p=0.74];(4)E/e’ Ratio change:5 observational studies were included,no significant difference was found [SMD=-0.25,95%CI(-0.51～0.00),p=0.05];(5)NT-pro BNP change:4 observational studies were included,no significant difference was found [SMD=-0.04,95%CI(-0.32～0.24),p=0.78];(6)PINP change:3 observational studies were included,no significant difference was found[SMD=0.1,95%CI(-0.53～0.73),p=0.76];(7)PIIINP:3 observational studies were included,no significant difference was found[SMD=0.32,95%CI(-0.01～0.65),p=0.05].Conclusions: ACEI/ARB/aldosterone receptor antagonists might have no effect on cardiac function in HCM.