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

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Abstract

Despite previous studies showing that patients with low systolic blood pressure (sBP) in heart failure with reduced ejection fraction (HFrEF) has a poor prognosis, it has few treatment options. This study aimed to investigate the efficacy and safety of sacubitril/valsartan (S/V) in HFrEF patients with hypotension. We included 43 consecutive HFrEF patients with sBP < 100 mmHg despite guideline-directed medical therapy for at least 3 months and who received S/V between September 2020 and July 2021. Patients admitted for acute heart failure were excluded and 29 patients were evaluated for safety endpoints. Furthermore, patients who performed non-pharmacological therapy or died within 1 month were excluded, finally, 25 patients were evaluated for efficacy endpoints. The mean initial S/V dose was 53.0 ± 20.5 mg/day and the mean dosage was increased to 84.0 ± 34.5 mg/day in 1 month. Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values significantly decreased from 2200 [interquartile range (IQR): 1462–3666] pg/ml to 1409 (IQR: 964–2451) pg/ml. (p < 0.0001). No significant change in sBP occurred (pre-sBP: 93.2 ± 4.9 mmHg, post-sBP: 93.4 ± 9.6 mmHg, p = 0.91), and no patients discontinued the S/V due to symptomatic hypotension in 1 month after S/V initiation. S/V can be safely introduced in HFrEF patients with hypotension to reduce serum NT-proBNP values. Thus, S/V may be useful for the treatment of HFrEF patients with hypotension.

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The data used in this study are available upon reasonable request.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Yu Takigami, Shunsuke Ishii, Yuko Eda, Mayu Yazaki, Teppei Fujita, Yuichiro Iida, Yuki Ikeda, Takeru Nabeta, Jun Oikawa, Toshimi Koitabashi & Junya Ako

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  1. Yu Takigami
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  2. Shunsuke Ishii
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Correspondence to Shunsuke Ishii.

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Takigami, Y., Ishii, S., Eda, Y. et al. The efficacy and safety of sacubitril/valsartan in heart failure with reduced ejection fraction patients with hypotension. Heart Vessels 38, 1337–1343 (2023). https://doi.org/10.1007/s00380-023-02283-4

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