ISBN: Table 61: ACE-inhibitor high dose versus low dose (CKD stages 3b-4) Outcomes No of Participants (studies) Follow up Quality of the evidence (GRADE) Relative effect Anticipated absolute effects Risk with low dose Risk difference with ACE-inhibitor high dose (CKD All-cause mortality 988 VERY LOWb,c due to risk of bias, indirectness Overall riska (from 52 fewer to 69 more) Mortality or Hospitalisation 988 VERY LOWb,c,d due to risk of bias, indirectness Overall riska (from 33 fewer to 36 more) Renal dysfunction or hyperkalaemia 988 VERY LOWb,c,d,e due to risk of bias, indirectness, imprecision (from 22 more to 159 more) VERY LOWb,c,d due to risk of bias, indirectness (from 66 more to 211 more) a Data insufficient to calculate control group, overall risk for CKD group given b Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias c Downgraded by 1 increment because the majority of evidence was from an indirect population (defined CKD in terms of creatinine, not eGFR) d Downgraded by 1 increment because the outcome was compound, and could not extract protocol outcome e Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 