Efficacy and safety of sacubitril/valsartan in patients with heart failure with reduced ejection fraction and hypotension

Abstract

Abstract Purpose It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure with reduced ejection fraction (HFrEF) and low systolic blood pressure (SBP). This study aimed to investigate the efficacy and tolerability of sacubitril/valsartan in HFrEF patients with SBP <100 mmHg under real-world conditions. Methods and results An observational study was conducted on 117 patients, 40.2% of whom had SBP <100 mmHg, and 59.8% had SBP ≥100 mmHg. Sacubitril/valsartan target doses were achieved in 52.4% of patients with SBP <100 mmHg and 70.0% of patients with SBP ≥100 mmHg. The effect of sacubitril/valsartan on left ventricular ejection fraction (LVEF) was observed in both SBP categories, with a 10.8% increase in patients with SBP <100 mmHg (P < 0.001) and a 14.0% increase in patients with SBP ≥100 mmHg (P < 0.001). A reduction in the concentration of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) was similar between patients with SBP <100 mmHg and SBP ≥100 mmHg (1627.5 pg/ml and 1340.1 pg/ml, respectively; P = 0.75). The effects of sacubitril/valsartan on SBP were significant inverse across both SBP categories (P = 0.001), with an increase of 7.5 mmHg in patients with SBP<100 mmHg and a reduction of 11.5 mmHg in patients with SBP ≥100 mmHg. There were no significant differences between the two groups in the incidence of symptomatic hypotension, worsening renal function, hyperkalemia, angioedema, or stroke. Conclusion In a real-life setting in patients with HFrEF and hypotension, sacubitril/valsartan was generally well tolerated and resulted in left ventricular reverse remodeling.