Treatment with Sacubitril/Valsartan Effectively Manages Hypertension and Ameliorates Left Ventricular Hypertrophy in Hemodialysis Patients.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-01-01 Epub Date: 2024-05-31 DOI:10.1159/000538899

Nan Hu, Nan Lv, Yuqing Chen

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Abstract

Introduction: The aim of this study was to investigate the role of sacubitril/valsartan in managing hypertension and cardiac remodeling in patients undergoing hemodialysis.

Methods: Hemodialysis patients with stable blood pressure control were enrolled in the study. Sacubitril/valsartan was prescribed to replace previously used angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or other antihypertensive drugs. During a 6-month follow-up period, pre-dialysis blood pressure, routine biochemical markers, and N-terminal pro-brain natriuretic peptide levels were measured. Volume status was assessed using bioelectrical impedance analysis. Endothelial damage was evaluated by measuring asymmetric dimethylarginine expression, while echocardiography and life quality assessed by Short Form-12 Health Survey were conducted at baseline and after treatment.

Results: The median daily dose of sacubitril/valsartan in 32 participants was 200 mg, and no obvious adverse reactions were reported. The defined daily dose of other antihypertensive drugs (baseline 2.00 ± 1.18, end point 1.46 ± 1.30, t = 3.216, p = 0.003) reduced significantly. After treatment with sacubitril/valsartan, left ventricular ejection fraction significantly increased from 64.81 ± 8.16% to 67.55 ± 5.85% (t = -4.022, p ≤ 0.001) and the thickness of posterior wall of the left ventricle reduced from 1.05 ± 0.14 cm to 1.00 ± 0.11 cm (t = 2.063, p = 0.048). The interventricular septal thickness (baseline 1.08 ± 0.16 cm, endpoint 1.02 ± 0.12 cm, t = 2.260, p = 0.031) remarkably reduced by the end of follow-up. The tricuspid regurgitation pressure gradient decreased from 28.47 ± 8.26 mm Hg at baseline to 23.79 ± 6.61 mm Hg (t = 2.531, p = 0.020) after treatment.

Conclusion: Sacubitril/valsartan effectively manages hypertension in hemodialysis patients and may also independently improve left ventricular hypertrophy and systolic function, regardless of changes in the blood pressure or the volume load.

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使用萨库比特利/缬沙坦治疗可有效控制血液透析患者的高血压并改善左心室肥大。

导言本研究旨在探讨沙库比妥/缬沙坦对血液透析患者高血压管理和心脏重塑的疗效。方法将血压控制稳定的血液透析患者纳入研究。用萨库布利/缬沙坦替代之前使用的 ACEI/ARB 或其他降压药。在 6 个月的随访期间，测量了透析前血压、常规生化指标和 N 端前脑钠肽水平。采用生物电阻抗分析法评估血容量状态。通过测量不对称二甲基精氨酸的表达评估了内皮损伤，同时在基线和治疗后进行了超声心动图检查和短表 12 生活质量评估。结果 32 名参与者服用沙库比妥/缬沙坦的日剂量中位数为 200 毫克，未报告明显的不良反应。其他降压药物的规定日剂量（基线为 2.00±1.18，终点为 1.46±1.30，t=3.216，P=0.003）显著减少。使用沙库比特利/缬沙坦治疗后，左室射血分数从（64.81±8.16）%明显增加到（67.55±5.85）%（t=-4.022，P≤0.001），左室后壁厚度从（1.05±0.14）厘米减少到（1.00±0.11）厘米（t=2.063，P=0.048）。室间隔厚度（基线 1.08±0.16厘米，终点 1.02±0.12厘米，t=2.260，P=0.031）在随访结束时显著减少。三尖瓣反流压力梯度从基线时的 28.47±8.26 mmHg 降至治疗后的 23.79±6.61 mmHg（t=2.531，P=0.020）。结论无论血压或容量负荷如何变化，沙库比特利/缬沙坦都能有效控制血液透析患者的高血压，还能独立改善左心室肥厚和收缩功能。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.