Six RCTs (8,425 participants, range 71 to 4,128) were included in the review. One study was classified as two substudies and considered separately in the meta-analysis. All studies had adequate allocation concealment and follow-up that was more than 90% complete.
There was no evidence of significant differences between groups in the risk of total or cardiovascular mortality (five studies, 8,273 participants).
Compared to placebo, in three studies (8,001 participants) RASI therapy was associated with a significant reduction in worsening of heart failure (OR 1.16, 95% CI 1.03 to 1.31). There was a non-significant trend favouring reduced hospitalisations for heart failure in the RASI group (OR 1.11, 95% CI 0.99 to 1.24).
Compared to placebo, in four studies (424 participants) RASI therapy was associated with a significant improvement in-six minute walking distance (SMD 0.34, 95% CI 0.18 to 0.50) and in quality of life scores (SMD -0.31, 95% CI -0.50 to -0.11).
Compared to placebo, in two studies (7,151 participants) RASI therapy was associated with significantly more hyperkalaemic events (OR 0.53, 95% CI 0.30 to 0.95) and worsening of renal failure (OR 0.65, 95% CI 0.50 to 0.85).