Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis

Abstract Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with heart failure and reduced ejection fraction (HFrEF). However, patients often do not receive sacubitril/valsartan because of concerns about hypotension....

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Autores principales:	Hyoeun Kim, Jaewon Oh, Sanghyup Lee, Jaehyung Ha, Minjae Yoon, Kyeong-hyeon Chun, Chan Joo Lee, Sungha Park, Sang-Hak Lee, Seok-Min Kang
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/aa72dddf037443319abf210345d1c0a0
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spelling	oai:doaj.org-article:aa72dddf037443319abf210345d1c0a02021-12-02T16:28:50ZClinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis10.1038/s41598-021-95787-w2045-2322https://doaj.org/article/aa72dddf037443319abf210345d1c0a02021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-95787-whttps://doaj.org/toc/2045-2322Abstract Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with heart failure and reduced ejection fraction (HFrEF). However, patients often do not receive sacubitril/valsartan because of concerns about hypotension. We examined the feasibility of initiating sacubitril/valsartan at a very low dose (VLD) in potentially intolerant patients with HFrEF and subsequent dose up-titration, treatment persistence and outcomes. We analyzed 206 patients with HFrEF grouped according to starting sacubitril/valsartan dose. The VLD group (n = 106) commenced 25 mg twice daily, and the standard-dose (SD) group (n = 100) started on ≥ 50 mg twice daily. Baseline systolic blood pressure was 103 ± 12 mmHg vs. 119 ± 14 mmHg in the SD group (P < 0.001). The maximal target dose achievement rate was higher in the SD group (27.0% vs 9.4%, p = 0.001) and the VLD group experienced more dose up-titrations and fewer down-titrations than the SD group. The VLD group had a decrease in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) similar to the SD group and a similar increase in left ventricular ejection fraction. There were no significant differences in symptomatic hypotension, worsening renal function, hyperkalemia, cardiovascular mortality, and rehospitalization due to HF between the two groups during follow-up period. In patients considered by the treating physician likely to be intolerant of sacubitril/valsartan, initiation with 25 mg twice daily was generally possible and patients remained in therapy, with similar decreases in NT-proBNP and increases in left ventricular ejection fraction to those observed in patients receiving SD sacubitril/valsartan.Hyoeun KimJaewon OhSanghyup LeeJaehyung HaMinjae YoonKyeong-hyeon ChunChan Joo LeeSungha ParkSang-Hak LeeSeok-Min KangNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Hyoeun Kim Jaewon Oh Sanghyup Lee Jaehyung Ha Minjae Yoon Kyeong-hyeon Chun Chan Joo Lee Sungha Park Sang-Hak Lee Seok-Min Kang Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
description	Abstract Sacubitril/valsartan is superior to enalapril in reducing the risks of cardiovascular death and preventing hospitalization in patients with heart failure and reduced ejection fraction (HFrEF). However, patients often do not receive sacubitril/valsartan because of concerns about hypotension. We examined the feasibility of initiating sacubitril/valsartan at a very low dose (VLD) in potentially intolerant patients with HFrEF and subsequent dose up-titration, treatment persistence and outcomes. We analyzed 206 patients with HFrEF grouped according to starting sacubitril/valsartan dose. The VLD group (n = 106) commenced 25 mg twice daily, and the standard-dose (SD) group (n = 100) started on ≥ 50 mg twice daily. Baseline systolic blood pressure was 103 ± 12 mmHg vs. 119 ± 14 mmHg in the SD group (P < 0.001). The maximal target dose achievement rate was higher in the SD group (27.0% vs 9.4%, p = 0.001) and the VLD group experienced more dose up-titrations and fewer down-titrations than the SD group. The VLD group had a decrease in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) similar to the SD group and a similar increase in left ventricular ejection fraction. There were no significant differences in symptomatic hypotension, worsening renal function, hyperkalemia, cardiovascular mortality, and rehospitalization due to HF between the two groups during follow-up period. In patients considered by the treating physician likely to be intolerant of sacubitril/valsartan, initiation with 25 mg twice daily was generally possible and patients remained in therapy, with similar decreases in NT-proBNP and increases in left ventricular ejection fraction to those observed in patients receiving SD sacubitril/valsartan.
format	article
author	Hyoeun Kim Jaewon Oh Sanghyup Lee Jaehyung Ha Minjae Yoon Kyeong-hyeon Chun Chan Joo Lee Sungha Park Sang-Hak Lee Seok-Min Kang
author_facet	Hyoeun Kim Jaewon Oh Sanghyup Lee Jaehyung Ha Minjae Yoon Kyeong-hyeon Chun Chan Joo Lee Sungha Park Sang-Hak Lee Seok-Min Kang
author_sort	Hyoeun Kim
title	Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
title_short	Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
title_full	Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
title_fullStr	Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
title_full_unstemmed	Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
title_sort	clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/aa72dddf037443319abf210345d1c0a0
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Clinical evidence of initiating a very low dose of sacubitril/valsartan: a prospective observational analysis

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