Impact of systolic blood pressure on the safety and tolerability of initiating and up-titrating sacubitril/valsartan in patients with heart failure and reduced ejection fraction: insights from the TITRATION study
| Autor: | Rolf Wachter, Inder S. Anand, Michele Senni, Victor Shi, Vincenzo Duino, Hugh F. McIntyre, John J.V. McMurray, Alan Charney, Arnab Sarkar |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry 030204 cardiovascular system & hematology medicine.disease Sacubitril 3. Good health 03 medical and health sciences 0302 clinical medicine Blood pressure Valsartan Tolerability Heart failure Internal medicine Post-hoc analysis medicine Cardiology 030212 general & internal medicine Cardiology and Cardiovascular Medicine business Sacubitril Valsartan medicine.drug |
| Zdroj: | European Journal of Heart Failure. 20:491-500 |
| ISSN: | 1388-9842 |
| DOI: | 10.1002/ejhf.1054 |
| Popis: | Aims: The TITRATION trial investigated two strategies to initiate and up-titrate sacubitril/valsartan (LCZ696) to the same target dose, over a condensed (3-week) or conservative (6-week) period, in patients with heart failure with reduced ejection fraction (HFrEF) and systolic blood pressure (SBP) of ≥100 mmHg. This post hoc analysis examined the relationship between baseline SBP at screening and achievement of the target dose of sacubitril/valsartan of 97 mg/103 mg (also termed ‘LCZ696 200 mg’) twice per day during the study. Methods and results: Patients (n = 498) were categorized in four groups based on SBP at screening: 100–110 mmHg (n = 70); 111–120 mmHg (n = 93); 121–139 mmHg (n = 168) and ≥140 mmHg (n = 167). Overall, 72.7%, 76.1%, 85.6% and 82.9%, respectively, of patients in these SBP categories achieved and maintained the target dose of sacubitril/valsartan without down-titration/dose interruption over 12 weeks (‘treatment success’). Compared with patients with SBP of 100–110 mmHg, rates of treatment success among patients in the higher SBP groups [111–120 mmHg (P = 0.96); 121–139 mmHg (P = 0.06) and ≥140 mmHg (P = 0.25)] did not differ significantly. A higher percentage of patients with lower SBP (100–110 mmHg) achieved treatment success with gradual up-titration (6 weeks) (∼80%) than with rapid up-titration (∼69%). Similar findings were observed with regard to ‘tolerability success’ (maintenance of the target dose for at least the final 2 weeks prior to study completion). Hypotension occurred more frequently in patients with lower SBP. Conclusions: The majority of patients (>80%) with SBP of ≥100 mmHg achieved and maintained the target dose of sacubitril/valsartan if the treatment was titrated gradually. These findings suggest that low SBP should not prevent clinicians from considering the initiation of sacubitril/valsartan. |
| Databáze: | OpenAIRE |
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