Key result
Low-dose sacubitril/valsartan linked to reduced NT-proBNP and ~18% of patients discontinuing diuretics.
Why the study?
Widespread ARNI use remains low because many patients cannot tolerate recommended starting doses due to hypotension.
Does lower than standard dose sacubitril/valsartan reduce NT-proBNP and diuretic requirements in patients unable to tolerate traditional therapy?
Cohort (n=45)
No
Does lower than standard dose sacubitril/valsartan reduce NT-proBNP and diuretic requirements in patients unable to tolerate traditional therapy?
Very low and low doses of sacubitril/valsartan significantly reduce NT-proBNP and diuretic requirements in patients unable to tolerate standard starting doses.
May support lower-dose sacubitril/valsartan titration; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Widespread use of angiotensin receptor blocker and neprilysin inhibitor (ARNI) remains low, and many patients are unable to tolerate the medication due to hypotension at the currently recommended starting dose. HYPOTHESIS: The aim of this study is to assess if lower than standard doses of ARNI, sacubitril/valsartan (S/V), significantly reduces NT-proBNP and leads to any change in diuretic dose, serum potassium, or creatinine. METHODS: In a retrospective study of 278 patients who were started on a low dose S/V at a single medical center, 45 patients were selected for the study cohort. Patients were subcategorized to Group 1 (n = 10): very low dose S/V (half a tab of 24/26 mg BID), Group 2 (n = 10): very low dose titrated to low dose S/V, and Group 3 (n = 25): low dose S/V (24/26 mg BID). NT-proBNP, diuretic dose, serum potassium, and creatinine were compared before and after initiation of S/V. RESULTS: Among all groups, there was a significant reduction in NT-proBNP level (Group 1: p < .01, Group 2: p < .01, and Group 3: p < .001). In addition, there was a significant reduction in diuretic dose across all groups combined (furosemide 53 mg/day vs. 73 mg/day; p = .03), with 17.8% (8/45) patients being able to discontinue their diuretic completely. There was no significant change in potassium or creatinine. CONCLUSIONS: Lower than standard dose of S/V significantly reduces NT-proBNP and diuretic requirement without change in potassium or creatinine, which provides hope that patients who cannot tolerate standard doses of S/V due to hypotension may be able to receive the benefits of S/V therapy.
No takes yet. Share an insight, caveat, or question.
Pandey et al. (2020) reported a cohort. Sacubitril/valsartan vs. Baseline (before initiation) was evaluated on NT-proBNP levels (p=<.01). Lower than standard doses of sacubitril/valsartan significantly reduced NT-proBNP (p<0.01) and diuretic requirements (53 vs 73 mg/day; p=0.03), with 17.8% discontinuing diuretics.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: