April 1, 2018Open Access
View Full PaperIncidence, Predictors, and Outcomes Associated With Hypotensive Episodes Among Heart Failure Patients Receiving Sacubitril/Valsartan or Enalapril
Structured PICO
Does sacubitril/valsartan reduce the composite outcome of cardiovascular death or heart failure hospitalization in heart failure patients compared with enalapril?
P
Population
Heart failure patients
I
Intervention
Sacubitril/valsartan
C
Comparator
Enalapril
O
Outcome
Composite outcome of cardiovascular death or heart failure hospitalizationcomposite
Although sacubitril/valsartan causes more symptomatic hypotension than enalapril in heart failure patients, it does not lead to more permanent discontinuations and provides similar clinical benefit regardless of prior hypotensive episodes.
Abstract
BACKGROUND: In PARADIGM-HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure), heart failure treatment with sacubitril/valsartan reduced the primary composite outcome of cardiovascular death or heart failure hospitalization compared with enalapril but resulted in more symptomatic hypotension. Concern on hypotension may be limiting use of sacubitril/valsartan in appropriate patients. METHODS AND RESULTS: interaction>0.90). CONCLUSIONS: Hypotension was more common with sacubitril/valsartan relative to enalapril in PARADIGM-HF but did not differentially affect permanent discontinuations. Patients with hypotension during run-in derived similar benefit from sacubitril/valsartan compared with enalapril as those who did not experience hypotension.