Evidence from these studies is summarised in the clinical evidence summary below(Table 60 to 65). See also the study selection flow chart in Appendix C, forest plots in Appendix E, study evidence tables in Appendix F, GRADE tables in Appendix H and excluded studies list in Appendix I. Table 59: Summary of studies included in the review Study Intervention and comparison Population Outcomes Comments ATLAS trial, Ryden (Massie Cleland ) Angiotensin converting enzyme (ACE) inhibitors. per day Angiotensin converting enzyme (ACE) inhibitors. Lisinopril 2.5-5mg per day Duration 4y average (median 46 months). N=988 patients with CKD Post-hoc subgroup analysis of multicentre trial HF: NYHA class III or IV (or class II if admission for acute decompensation of heart failure in last 6 months) with ejection fraction 30%, who had received diuretics for at least 60 days CKD subgroup: Creatinine between 1.5 and 2.5 mg/dl, which equates to eGFR , therefore mostly stage Mortality Hospitalisation Hyperkalaemia 94. 31% of patients in trial had CKD stage Subgroup status: Ejection fraction: All reduced NYHA class: Mixed (mainly III) Industry funded Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Study Intervention and comparison Population Outcomes Comments CHARM- Overall trial: (Pfeffer ) Angiotensin receptor antagonists. Candesartan up to 32mg (as tolerated) Placebo average (range 2-4y). N=154 patients with CKD Subgroup analysis, pre- specified but not stratified HF: symptomatic HF (NYHA II-IV) for at least four weeks CKD subgroup: Creatinine between 2 and 3 mg/dl, equating approximately to GFR , stage 3b-4 Hospitalisation Hyperkalaemia Analysis of pooled results of three trials (looking at ARBs in different HF populations). 2% of patients in trials had CKD stage 3b+ Subgroup status: Ejection fraction: Mixed NYHA class: Mixed (II-IV) Industry funded HEAAL trial: Konstam Angiotensin receptor antagonists. 