Sacubitril/Valsartan in Heart Failure with Hypertension Patients: Real-World Experiences on Different Ages, Drug Doses, and Renal Functions.

IF 3.1 Q2 PERIPHERAL VASCULAR DISEASE High Blood Pressure & Cardiovascular Prevention Pub Date : 2023-11-01 Epub Date: 2023-11-18 DOI:10.1007/s40292-023-00606-0
Yingyun Guan, Xiaoye Li, Hui Li, Jinmei Ren, Kouming Tang, Chi Zhang, Zhichun Gu, Xiaoyu Li, Qianzhou Lv, Xiaolan Bian
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Abstract

Introduction: Hypertension is a significant risk factor in heart failure for worldwide patients. More than half of hypertensive patients suffer from heart failure. Recently, sacubitril/valsartan (sac/val) has been approved as an antihypertensive agent in China and Japan. Additionally, it is not approved for treating hypertension in Europe or the USA.

Aim: To accumulate more real-world experiences to investigate the effectiveness and optimize clinical medication of sac/val in hypertensive patients with heart failure.

Methods: We retrospectively enrolled adult patients diagnosed with hypertension (HTN) and heart failure (HF) and newly treated with sac/val. The baseline characteristics and clinical outcomes were retrospectively extracted from electronic medical records (EMR) in three centers. The efficacy and safety of sac/val were first analyzed in all enrolled patients. Stratified analyses were conducted in patients with different ages (≥ 65, < 65), maximum tolerated doses (≥ 200 mg/days, < 200 mg/days), and renal functions (e-GFR ≥ 60 ml/min/1.73 m2, < 60 ml/min/1.73 m2).

Results: Overall, 794 patients diagnosed with both HF and HTN were included in our study. During follow-up, significant reductions were found in blood pressure (BP) (SBP 12.8 ± 21.2 mmHg, P < 0.001, DBP 7.1 ± 16.5 mmHg, P < 0.001), and cardiac biomarkers (cardiac troponin 1.78 ± 19.1 ng/mL, P < 0.001, NT-proBNP 1403 ± 6937 pg/mL, P < 0.001) from baseline. In stratification analyses, the lower dosage group earned a higher BP control rate (83.4% vs. 75.6%, P = 0.025) and an overall improvement rate of cardiac indicators (61.3% vs. 48.0%, P = 0.002). The younger patients' group had significantly less cumulative hazard of recurrent cerebral-cardiovascular events than the elder group (log-rank P value < 0.001). Patients with renal dysfunction were observed with more AE incidences.

Conclusions: Sac/val could reduce BP and improve cardiac structural and functional parameters in hypertensive patients with HF, even with less than target doses. However, more attention should be paid to older patients and renal dysfunction patients when using sac/val because of additional risks in adverse events.

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沙比利/缬沙坦治疗心力衰竭合并高血压患者:不同年龄、药物剂量和肾功能的真实世界经验。
导读:高血压是全世界患者心力衰竭的重要危险因素。一半以上的高血压患者患有心力衰竭。最近,sacubitril/缬沙坦(sac/val)在中国和日本被批准为抗高血压药物。此外,它在欧洲或美国未被批准用于治疗高血压。目的:为探讨囊/val在高血压合并心力衰竭患者中的疗效及优化临床用药积累更多现实经验。方法:我们回顾性地招募了诊断为高血压(HTN)和心力衰竭(HF)并新近接受囊/val治疗的成年患者。回顾性地从三个中心的电子病历(EMR)中提取基线特征和临床结果。首先在所有入组患者中分析了sac/val的有效性和安全性。对不同年龄(≥65、< 65)、最大耐受剂量(≥200 mg/天、< 200 mg/天)和肾功能(e-GFR≥60 ml/min/1.73 m2, 2)的患者进行分层分析。结果:总体而言,794例诊断为HF和HTN的患者纳入了我们的研究。在随访期间,发现血压(SBP)显著降低(SBP 12.8±21.2 mmHg, P)。结论:Sac/val可降低高血压合并HF患者的血压,改善心脏结构和功能参数,即使低于目标剂量。然而,在使用sac/val时,更应注意老年患者和肾功能不全患者,因为有额外的不良事件风险。
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来源期刊
CiteScore
5.70
自引率
3.30%
发文量
57
期刊介绍: High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes:   Invited ''State of the Art'' reviews.  Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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