Patient Focus: Should you take sacubitril/valsartan if you have heart failure with an ejection fraction >40% and get low blood pressure? An explanation of “Association of Sacubitril/Valsartan versus Valsartan with Blood Pressure Changes, and Symptomatic Hypotension: The PARAGLIDE-HF Trial”

In this issue of the Journal of Cardiac Failure, Dr. Marat Fudim and colleagues explore the effects of using sacubitril/valsartan, a type of medicine called an angiotensin receptor-neprilysin inhibitor (ARNI), in patients with heart failure and a left ventricular ejection fraction more than 40% who develop low blood pressure. 1 DDC Marat Fudim Ward Jonathan H. Hernandez Adrian F. Lepage Serge Morrow David A. Sharma Kavita Claggett Brian L. Starling Randall C. Velazquez Eric J. Williamson Kristin M. Desai Akshay S. Zieroth Shelley Solomon Scott D. Braunwald Eugene Mentz Robert J. Association of Sacubitril/Valsartan versus Valsartan with Blood Pressure Changes, and Symptomatic Hypotension: The PARAGLIDE-HF Trial. Journal of Cardiac Failure. 2024; Google Scholar Often times, medicines for heart failure are considered based on how well the heart can squeeze, or the ejection fraction. Many medicines are known to be helpful when the ejection fraction is less than or equal to 40%, but not as many are shown to be helpful when the ejection fraction is more than 40%. Recent studies have shown a benefit with sacubitril/valsartan across a range of ejection fractions, and it is now approved by the Food and Drug Administration (FDA) for treating people who have heart failure no matter what the ejection fraction is. 2 Solomon SD Vaduganathan M LC B Packer M Zile M Swedberg K Rouleau J AP M Desai A Lund LH et al. Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. Circulation. 2020; 141: 352-361https://doi.org/10.1161/CIRCULATIONAHA.119.044586 Crossref PubMed Scopus (347) Google Scholar ,3 Nie D Xiong B Qian J Rong S Yao Y Huang J. The Effect of Sacubitril-Valsartan in Heart Failure Patients With Mid-Range and Preserved Ejection Fraction: A Meta-Analysis. Heart Lung Circ. 2021; 30: 683-691https://doi.org/10.1016/j.hlc.2020.10.012 Abstract Full Text Full Text PDF Scopus (17) Google Scholar Association of Sacubitril/Valsartan versus Valsartan with Blood Pressure Changes, and Symptomatic Hypotension: The PARAGLIDE-HF TrialJournal of Cardiac FailurePreview: In PARAGLIDE-HF, among patients with ejection fraction (EF) >40%, stabilized after worsening heart failure (WHF), sacubitril/valsartan led to greater reduction in plasma NT-proBNP levels and was associated with clinical benefit compared to valsartan alone, despite more symptomatic hypotension (SH). Concern over SH may be limiting use of sacubitril/valsartan in appropriate patients.