Risk stratification by renal function and NYHA class in patients with hypotension initiated on sacubitril/valsartan: a retrospective cohort study from 17 centres in Japan.

Autor:	Kanaoka K; Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan kanaokak@ncvc.go.jp.; Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan., Nasu T; Department of Internal Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan., Kikuchi A; Osaka General Medical Center, Osaka, Japan., Ijichi T; Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan., Shibata T; Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan., Kida K; Cardiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan., Kagiyama N; Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.; Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Japan., Fujimoto W; Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.; Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan., Ishii S; Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, none, Japan., Iwanaga Y; Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan., Miyamoto Y; Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan., Matsumoto S; Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Japan.
Jazyk:	angličtina
Zdroj:	Open heart [Open Heart] 2024 Oct 21; Vol. 11 (2). Date of Electronic Publication: 2024 Oct 21.
DOI:	10.1136/openhrt-2024-002764
Abstrakt:	Background: Patients with heart failure exhibiting low systolic blood pressure (SBP) have a poor prognosis. Sacubitril/valsartan reduces cardiovascular events; however, its use in patients with low SBP has not been fully examined. Therefore, in this study, we aimed to investigate the association between baseline SBP and adverse events (AEs) in patients starting sacubitril/valsartan therapy using data from a real-world registry in Japan. Methods: We analysed data from a multicentre retrospective study, including patients who initiated sacubitril/valsartan between August 2020 and August 2021. The patients were categorised into five groups based on their baseline SBP (<100, 100-109, 110-119, 120-129 and ≥130 mm Hg). The composite of AEs occurring within 3 months according to baseline SBP and the patient characteristics associated with AEs in a baseline SBP <110 mm Hg were analysed. Results: Among the 964 patients newly prescribed sacubitril/valsartan, the median (IQR) age was 73 (61-80) years, and 388 (40.2%) patients had a baseline SBP <110 mm Hg. AEs occurred in 24% (n=232) of patients. The adjusted ORs for all AEs were 1.91 (95% CI (CI) 1.13-3.23; p=0.02) for the SBP <100 mm Hg group and 3.33 (95% CI 1.98 to 5.59; p<0.001) for the SBP 100-109 mm Hg group, compared with the SBP 110-119 mm Hg group. In patients with a baseline SBP <110 mm Hg, factors associated with an increased risk of AEs included a higher New York Heart Association class (II, III or IV) and a lower estimated glomerular filtration rate <30 mL/min/1.73 m 2 . Conclusions: Caution is needed when initiating sacubitril/valsartan in patients with lower baseline SBP. The severity of heart failure and kidney function may be useful for risk stratification in these high-risk patients. Competing Interests: Competing interests: K Kanaoka received speaker honoraria from Eli Lilly Japan and Otsuka Pharmaceutical Co., Ltd. K Kida received honorariums from AstraZeneca, Ono Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Otsuka Pharmaceutical Co., Ltd. and Novartis Pharmaceuticals Co., Ltd. SM received research grants and personal fees from Abbott, Bayer Pharma, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic, Novartis, Ono Pharma, Orbus Neich, Otsuka Pharma and the Uehara Memorial Foundation. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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