The following is a summary of “Sacubitril/Valsartan vs. Valsartan and Symptomatic Hypotension,” published in the June 2024 issue of Cardiology by Fudim et al.
Researchers conducted a retrospective study exploring whether sacubitril/valsartan, compared to valsartan alone, leads to symptomatic hypotension in patients with heart failure (HF).
They conducted the PARAGLIDE-HF trial, comparing sacubitril/valsartan to valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP), safety, and tolerability in patients with worsening HF for patients diagnosed with HF with preserved ejection fraction (HFpEF) or HF with mildly reduced EF (HFmrEF). Data on symptomatic hypotension was collected in the PARAGLIDE-HF. In the follow-up, blood pressure measurements and patient symptoms were assessed. Outcomes were based on changes in NT-proBNP through weeks 4 and 8 and cardiovascular events (CEs), hospitalization for HF, and urgent visits.
The results showed that in the PARAGLIDE-HF study, 466 patients were randomized to either sacubitril/valsartan or valsartan. Out of 92 (19.7%), symptomatic hypotension was present, 24% had sacubitril/valsartan, and 15.5% had valsartan only. Serious hypotension occurred at similar times for both groups (18 days vs. 15 days, P=0.42). Medication changes were most familiar with sacubitril/valsartan (42.9% vs. 16.7%, P=0.009). Factors linked to symptomatic hypotension included being White (OR, 1.87, 95% CI: 0.31-11.15), lower baseline systolic BP (per 10 mm Hg increase: OR, 0.68; 95% CI: 0.55-0.85), and LVEF>60% (OR, 2.21; 955 CI, 1.05-4.65). NT-proBNP changes didn’t differ by baseline BP ≥128 mm Hg versus ≤128 mm Hg (Interaction P=0.43).
Investigators concluded that sacubitril/valsartan reduces NT-proBNP and offers extra benefits for HFpEF and patients with HRmEF despite more symptomatic hypotension, especially in those with higher LVEF, lower baseline systolic BP, and White race.
Source: acc.org/Latest-in-Cardiology/Journal-Scans/2024/06/20/15/15/association-of-sacubitril
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