Randomised controlled trials (RCTs) that assessed the use of renin-angiotensin system inhibitors in patients with chronic symptomatic heart failure, with preserved left ventricular ejection fraction of 0.40 or more, were eligible for inclusion. Trials had to have follow-up of at least one year. The outcomes of interest were all-cause mortality and hospitalisation for heart failure.
In the included trials, the mean age of participants ranged from 67 to 75 years; 41 to 61% were women. Twenty-six to 79% of included patients had New York Heart Association (NYHA) Class III or IV heart failure; their mean left ventricular ejection fraction ranged from 54 to 64%. Aetiology of heart failure was ischaemic or hypertensive; some patients had hypertension, diabetes, atrial fibrillation, angina or had previous percutaneous coronary interventions or coronary artery bypass. Drugs assessed were irbesartan, candesartan and perindopril. Other concomitant drugs included diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, digoxin, nitrates or calcium channel blockers.
The authors did not state how the papers were selected for the review.