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. 2023 Aug 8;75(1):68.
doi: 10.1186/s43044-023-00398-7.

Telmisartan versus EnalapRil In heart failure with redUced ejection fraction patients with Moderately impaired kidney Functions; randomized controlled trial: "TRIUMF trial"

Ahmad Samir  1 , Salma Aboel-Naga  2 , Ahmed Shehata  2 , Magdy Abdelhamid  2
Affiliations

Telmisartan versus EnalapRil In heart failure with redUced ejection fraction patients with Moderately impaired kidney Functions; randomized controlled trial: "TRIUMF trial"

Ahmad Samir et al. Egypt Heart J. .

Abstract

Background: When heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) co-exist, Renin angiotensin-aldosterone system inhibitors (RAASi) are often underutilized for the fear of worsening renal function (WRF). Telmisartan is a RAASi characteristic for a favorable renal profile, although data on its utility in HFrEF is limited. This study aimed to compare efficacy and tolerability of Telmisartan versus Enalapril in patients with HFrEF and CKD.

Results: This study randomized 107 patients with HFrEF and CKD to either Telmisartan (10-80 mg) or Enalapril (5-40 mg) daily. The achieved RAASi dose, dose reductions (DR) or dis-continuation (DC), death/Heart failure rehospitalization (HFH), NYHA class and 6MWT were compared at 3- and 6-months. At 3- and 6-months, 93.5% versus 68.6% and 95.2% versus 72.9% were maintaining ≥ 50% of the target dose in the Telmisartan- versus Enalapril-group, respectively. Despite the higher achieved dose by 3- and 6-months, Telmisartan versus Enalapril was associated with less WRF (6.4% vs. 22.9%, p = 0.022 and 7.3% vs. 13.6%, p = 0.28) and fewer episodes of DR-DC (31.9% vs. 55.1%, p = 0.018 and 35.7% vs. 56.5%, p = 0.041), respectively. By the end of the study, there were 5 deaths in each group, yet, HFH occurred in 34.1% versus 55.3%, p = 0.035, and NYHA class changed by - 1 [- 2, 0] versus 0 [- 1, 1], p = 0.017 in Telmisartan- versus Enalapril patients, respectively. Within-group results showed improvement in 6MWT in Telmisartan-, and increase in diuretic requirements in Enalapril-group.

Conclusions: In patients with HFrEF and CKD, Telmisartan was better tolerated to uptitrate, caused less WRF, less HFH and showed better functional improvement compared to Enalapril. Clinical trial registration This study was prospectively registered on clinicaltrials.gov, with registration number (NCT04736329).

Keywords: Chronic kidney disease CKD; Enalapril; Heart failure with reduced ejection fraction HFrEF; Telmisartan; Worsening renal function WRF.

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Conflict of interest statement

None of the authors have competing or conflicting interests that are directly or indirectly related to the work submitted for this publication.

Figures

Fig. 1
Fig. 1
Flow chart for the study recruitment process
Fig. 2
Fig. 2
A Distribution of NYHA class across the Telmisartan- and Enalapril groups at baseline and by the end of the study. B Mann–Whitney testing of the NYHA class shifts through the study period (baseline -to-6 months) expressed as − 1 for each class improvement (i.e., IV-to-III) and + 1 for each class deterioration (i.e., II-to-III)
Fig. 3
Fig. 3
A Scores of 6MWT for the 2 groups at baseline and by the end of the study with demonstration of the within-group p value. B Daily requirements of the standardized loop diuretics dose from baseline to the end of the study demonstrating changes in dose requirements and the p values of within-group differences between baseline-to-6 months and 3-to-6 months
See this image and copyright information in PMC

References

    1. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022;145:895–1032. - PubMed
    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726. doi: 10.1093/eurheartj/ehab368/6358045. - DOI - PubMed
    1. Schwinger RHG. Pathophysiology of heart failure. Cardiovasc Diagn Ther. 2021;11(1):263–276. doi: 10.21037/cdt-20-302. - DOI - PMC - PubMed
    1. Oliveros E, Oni ET, Shahzad A, Kluger AY, Lo KB, Rangaswami J, McCullough PA. Benefits and risks of continuing angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and mineralocorticoid receptor antagonists during hospitalizations for acute heart failure. Cardiorenal Med. 2020;10(2):69–84. doi: 10.1159/000504167. - DOI - PubMed
    1. Greene SJ, Butler J, Albert NM, DeVore AD, Sharma PP, Duffy CI, Hill CL, McCague K, Mi X, Patterson JH, Spertus JA, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry. J Am Coll Cardiol. 2018;72(4):351–366. doi: 10.1016/j.jacc.2018.04.070. - DOI - PubMed

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