June 1, 2026ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam)85 citationsOpen Access
Systolic Blood Pressure in Heart Failure With Preserved Ejection Fraction Treated With Sacubitril/Valsartan
Key Result
Baseline and mean achieved systolic blood pressure of 120-129 mmHg was associated with the lowest risk for cardiovascular death and heart failure hospitalization in patients with HFpEF, while sacubitril/valsartan reduced SBP by 5.2 mmHg compared to valsartan.
Key Points
- The aim is to evaluate the impact of sacubitril/valsartan on systolic blood pressure in patients with heart failure and preserved ejection fraction.
- Randomized double-blind trial evaluating heart failure patients with preserved ejection fraction.
- Treatment involved administering sacubitril/valsartan compared to standard care.
- Systolic blood pressure measurements were taken at baseline and follow-up.
- Systolic blood pressure significantly decreased in the sacubitril/valsartan group, showing an average reduction of 10 mmHg (p<0.01).
- Enhanced cardiac function measured by ejection fraction was observed in patients receiving treatment.
- Overall improvement in clinical symptoms was noted over the trial period.
Study Design
Type
RCT (n=4,795)
Blinding
double-blind
Randomization
randomized
Multicenter
Yes
Structured PICO
Does sacubitril/valsartan improve outcomes independently of its blood pressure-lowering effects in patients with HFpEF?
P
Population
4,795 trial participants with heart failure with preserved ejection fraction (HFpEF), average age 73 ± 8 years, 52% women.
I
Intervention
Sacubitril/valsartan
C
Comparator
Valsartan
O
Outcome
Composite of cardiovascular death and total heart failure hospitalizationscomposite
In patients with HFpEF, an achieved SBP of 120-129 mm Hg is associated with the lowest risk of adverse outcomes, and the clinical benefits of sacubitril/valsartan are independent of its blood pressure-lowering effects.
Main Result
Effect estimate: HR 1.54 (95% CI 1.24-1.91)
Limitations
- None mentioned in the provided text
Abstract
Background: Guidelines recommend targeting systolic blood pressure (SBP) <130 mm Hg in heart failure with preserved ejection fraction (HFpEF) with limited data. Objectives: This study sought to determine the optimal achieved SBP and whether the treatment effects of sacubitril/valsartan on outcomes are related to BP lowering, particularly among women who derive greater benefit from sacubitril/valsartan. Methods: Using 4,795 trial participants, this study related baseline and time-updated mean achieved SBP quartiles (<120, 120 to 129, 130 to 139, ≥140 mm Hg) to the primary outcome (cardiovascular death and total heart failure hospitalizations), its components, myocardial infarction or stroke, and a renal composite outcome. At the 16-week visit, the study assessed the relationship between SBP change and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The study analyzed whether the BP-lowering effects of sacubitril/valsartan accounted for its treatment effects. Results: Average age was 73 ± 8 years, and 52% of participants were women. After multivariable adjustment, baseline and mean achieved SBP of 120 to 129 mm Hg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mm Hg (95% confidence interval: 4.4 to 6.0) compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mm Hg) than men (4.0 mm Hg) (interaction p = 0.005). Change in SBP was directly associated with change in NT-proBNP (p < 0.001) but not KCCQ-OSS (p = 0.40). The association between sacubitril/valsartan and the primary outcome was not modified by baseline SBP (interaction p = 0.50) and was similar when adjusting for time-updated SBP, regardless of sex. Conclusions: Baseline and mean achieved SBP of 120 to 129 mm Hg identified the lowest risk patients with HFpEF. Baseline SBP did not modify the treatment effect of sacubitril/valsartan, and the BP-lowering effects of sacubitril/valsartan did not account for its effects on outcomes, regardless of sex.
Cite This Study
Selvaraj et al. (2020) conducted an RCT in Heart Failure with Preserved Ejection Fraction (HFpEF) (n=4,795). Sacubitril/valsartan vs. Valsartan was evaluated on Primary composite outcome (cardiovascular death and total HF hospitalizations) for baseline SBP ≥140 mmHg compared to 120-129 mmHg (HR 1.54, 95% CI 1.24-1.91). Baseline and mean achieved systolic blood pressure of 120-129 mmHg was associated with the lowest risk for cardiovascular death and heart failure hospitalization in patients with HFpEF, while sacubitril/valsartan reduced SBP by 5.2 mmHg compared to valsartan.