Authors :
Mark Paul Mayala; Henry Mayala; Khuzeima Khanbhai
Volume/Issue :
Volume 8 - 2023, Issue 2 - February
Google Scholar :
https://bit.ly/3IIfn9N
Scribd :
https://bit.ly/3kcObda
DOI :
https://doi.org/10.5281/zenodo.7664502
Abstract :
Heart failure has been a rising concern in
Tanzania. New drugs have been introduced, including
the group of drugs called Angiotensin receptor
Neprilysin inhibitors (ARNI), but due to their high cost,
angiotensin-converting enzymes inhibitors (ACEIs) and
Angiotensin receptor blockers (ARBs) have been mostly
used in Tanzania. However, according to our knowledge,
the efficacy comparison of the two groups is yet to be
studied in Tanzania. The aim of this study was
to compare the efficacy of ACEIs and ARBs among
patients with heart failure.
This was a hospital-based prospective cohort study
done at Jakaya Kikwete Cardiac Institution (JKCI),
Tanzania, from June to December 2020. Consecutive
enrollment was done until fulfilling the inclusion criteria.
Clinical details were measured at baseline. We assessed
the relationship between ARBs and ACEI users with Nterminal pro-Brain natriuretic peptide (NT pro-BNP)
levels at admission and at 1-month follow-up using a chisquare test. A Kaplan-Meier curve was used to estimate
the survival time of the two groups.
155 HF patients were enrolled, with a mean
age of 48 years, whereby 52.3% were male, and their
mean left ventricular ejection fraction (LVEF) was
37.3%. 52 (33.5%) heart failure patients were on ACEIs,
57 (36.8%) on ARBs, and 46 (29.7%) were neither using
ACEIs nor ARBs. At least half of the patients did not
receive a Guideline directed medical therapy (GDMT),
with only 82 (52.9%) receiving a GDMT. A drop in NT
pro-BNP levels was observed during admission and at 1-
month follow-up on both groups, from 6389.2pg/ml to
4000.1pg/ml for ARB users and 5877.7pg/ml to
1328.2pg/ml for the ACEIs users. There was no
statistical difference between the two groups when
estimated by the Kaplan-Meier curve, though, more
deaths were observed in those who were neither on
ACEIs nor ARBs, with a calculated P value of 0.01.
This study demonstrates that ACEIs have more
efficacy and overall better clinical outcome than ARBs,
but this should be taken under the patient-based case,
considering the side effects of ACEIs and patients’
adherence.
Keywords :
Angiotensin Converting Enzymes Inhibitors, Angiotensin Receptor Blockers, Guideline Direct Medical Therapy, N-Terminal Pro-Brain Natriuretic Peptide.
Heart failure has been a rising concern in
Tanzania. New drugs have been introduced, including
the group of drugs called Angiotensin receptor
Neprilysin inhibitors (ARNI), but due to their high cost,
angiotensin-converting enzymes inhibitors (ACEIs) and
Angiotensin receptor blockers (ARBs) have been mostly
used in Tanzania. However, according to our knowledge,
the efficacy comparison of the two groups is yet to be
studied in Tanzania. The aim of this study was
to compare the efficacy of ACEIs and ARBs among
patients with heart failure.
This was a hospital-based prospective cohort study
done at Jakaya Kikwete Cardiac Institution (JKCI),
Tanzania, from June to December 2020. Consecutive
enrollment was done until fulfilling the inclusion criteria.
Clinical details were measured at baseline. We assessed
the relationship between ARBs and ACEI users with Nterminal pro-Brain natriuretic peptide (NT pro-BNP)
levels at admission and at 1-month follow-up using a chisquare test. A Kaplan-Meier curve was used to estimate
the survival time of the two groups.
155 HF patients were enrolled, with a mean
age of 48 years, whereby 52.3% were male, and their
mean left ventricular ejection fraction (LVEF) was
37.3%. 52 (33.5%) heart failure patients were on ACEIs,
57 (36.8%) on ARBs, and 46 (29.7%) were neither using
ACEIs nor ARBs. At least half of the patients did not
receive a Guideline directed medical therapy (GDMT),
with only 82 (52.9%) receiving a GDMT. A drop in NT
pro-BNP levels was observed during admission and at 1-
month follow-up on both groups, from 6389.2pg/ml to
4000.1pg/ml for ARB users and 5877.7pg/ml to
1328.2pg/ml for the ACEIs users. There was no
statistical difference between the two groups when
estimated by the Kaplan-Meier curve, though, more
deaths were observed in those who were neither on
ACEIs nor ARBs, with a calculated P value of 0.01.
This study demonstrates that ACEIs have more
efficacy and overall better clinical outcome than ARBs,
but this should be taken under the patient-based case,
considering the side effects of ACEIs and patients’
adherence.
Keywords :
Angiotensin Converting Enzymes Inhibitors, Angiotensin Receptor Blockers, Guideline Direct Medical Therapy, N-Terminal Pro-Brain Natriuretic Peptide.