Novel doses of sacubitril/valsartan in patients unable to tolerate traditional therapy: Effects on N-terminal pro B-type natriuretic peptide levels.
Novel doses of sacubitril/valsartan in patients unable to tolerate traditional therapy: Effects on N-terminal pro B-type natriuretic peptide levels.
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DOI：
10.1002/clc.23509
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发表时间：
2021-01
影响因子：
2.7
通讯作者：
Heywood JT
中科院分区：
文献类型：
--
作者：
Pandey AC;Jer D;Kuo RS;Yoo DH;Christophy A;Mohan RC;Srivastava AV;Heywood JT
血管紧张素受体阻滞剂和neprilysin抑制剂（ARNI）的广泛使用仍然很低，许多患者在目前推荐的起始剂量下由于低血压而无法耐受药物。本研究的目的是评估低于标准剂量的ARNI、sacubitril/缬沙坦（S/V）是否显著降低NT - proBNP，并导致利尿剂剂量、血清钾或肌酐的变化。在一项回顾性研究中，278名患者在一个医疗中心开始接受低剂量S/V治疗，其中45名患者被选为研究队列。将患者分为组1 (n = 10)：极低剂量S/V（半片24/26 mg BID），组2 (n = 10)：极低剂量滴至低剂量S/V，组3 (n = 25)：低剂量S/V （24/26 mg BID）。比较S/V开始前后的NT‐proBNP、利尿剂剂量、血清钾和肌酐。在所有组中，NT‐proBNP水平均显著降低（第一组：p < 0.05）。01、第二组：p <。3组：p < 0.001)。此外，所有联合用药组的利尿剂剂量均显著减少（呋塞米53 mg/天vs 73 mg/天；p = .03）， 17.8%（8/45）患者能够完全停用利尿剂。钾和肌酐没有明显变化。低于标准剂量的S/V可显著降低NT - proBNP和利尿剂需求，而钾或肌酐没有变化，这为因低血压而不能耐受标准剂量S/V的患者提供了希望，他们可能能够从S/V治疗中获益。
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. 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. 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. 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. 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.
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影响因子：
37.8
作者：
Yancy, Clyde W.;Jessup, Mariell;Westlake, Cheryl
通讯作者：
Westlake, Cheryl
DOI：
10.1136/heartjnl-2014-306775
发表时间：
2016-09-01
期刊：
Heart (British Cardiac Society)
影响因子：
--
作者：
Jhund PS;McMurray JJ
通讯作者：
McMurray JJ
影响因子：
37.8
作者：
Benjamin EJ;Blaha MJ;Chiuve SE;Cushman M;Das SR;Deo R;de Ferranti SD;Floyd J;Fornage M;Gillespie C;Isasi CR;Jiménez MC;Jordan LC;Judd SE;Lackland D;Lichtman JH;Lisabeth L;Liu S;Longenecker CT;Mackey RH;Matsushita K;Mozaffarian D;Mussolino ME;Nasir K;Neumar RW;Palaniappan L;Pandey DK;Thiagarajan RR;Reeves MJ;Ritchey M;Rodriguez CJ;Roth GA;Rosamond WD;Sasson C;Towfighi A;Tsao CW;Turner MB;Virani SS;Voeks JH;Willey JZ;Wilkins JT;Wu JH;Alger HM;Wong SS;Muntner P;American Heart Association Statistics Committee and Stroke Statistics Subcommittee
通讯作者：
American Heart Association Statistics Committee and Stroke Statistics Subcommittee
DOI：
10.1016/j.jchf.2019.08.003
发表时间：
2020-01
期刊：
JACC. Heart failure
影响因子：
--
作者：
Tan NY;Sangaralingham LR;Sangaralingham SJ;Yao X;Shah ND;Dunlay SM
通讯作者：
Dunlay SM
影响因子：
2
作者：
Fajardo, Jeff;Heywood, J. Thomas;Chow, Sheryl L.
通讯作者：
Chow, Sheryl L.