Efficacy of allopurinol for chronic heart failure：a systematic review of randomized controlled trials

Abstract:

Objective：To systemically review the effects of allopurinol on heart systolic function in patients with chronic heart failure. Methods：Randomized controlled trials（RCTs） in electronic databases（PubMed，The Cochrane library，ISI，CBM，CNKI，VIP and WanFang Data） and article reference lists（until August 2014） were searched，The therapeutic effects of allopurinol on patients with chronic heart failure were reviewed using Ｍeta-analytical techniques. Mean difference（MD） or standard MD（SMD） and relevant 95% confidence interval（CI） for continuous variables，relative risk（RR） and relevant 95%CI for dichotomous data were calculated. The RevMan 5.3 software package was used for the Ｍeta-analysis. Results：A total of 21 RCTs with 1 384 chronic heart failure patients were included in the Ｍeta-analysis. The present Ｍeta-analysis showed that there was a significantly higher left ventricular ejection fraction（LVEF） in allopurinol arm than that in control arm（MD=5.83，95%CI=4.65 to 7.01，P=0.000）. Subgroup analysis consistently suggested that allopurinol can significantly improve the LVEF regardless of whether included patients suffered from hyperuricemia（MD=6.09，95%CI=4.73 to 7.45，P=0.000），or not（MD=4.49，95%CI=2.99 to 5.99，P=0.000） at baseline，respectively. Similarly，allop－urinol can also significantly decrease the plasma B-type natriuretic peptide（BNP）/N terminal pro-BNP（NT-proBNP） level than control group（SMD=-0.62，95%CI=-1.00 to -0.24，P=0.001）. Three RCTs reported the side effects of allopurinol，and there was no significant difference in incidence of the side effects between the two arms. Conclusion：The present Meta-analysis suggested that conventional treatment combined with allopurinol therapy for chronic heart failure is effective and safe. Due to the limitation of the quality of included studies，this conclusion should be further confirmed with more high quality and large sample studies.