Significant impact of sacubitril/valsartan on LV remodeling among HF patients with low blood pressure

21 Sep 2023

​Despite being prioritized as a first-line drug for heart failure (HF) patients with left ventricular ejection fraction (LVEF) <50%, the clinical efficacy of sacubitril/valsartan among HF patients with low blood pressure remains undetermined due to its reported potency in blood pressure reduction which precluded most clinical studies from continuing with sacubitril/valsartan.1 Hence, a retrospective study was conducted to evaluate the efficacy of sacubitril/valsartan on left ventricular (LV) remodeling for HF patients with LVEF <50% and systolic blood pressure ≤100mmHg.1  

A total of 164 HF patients with LVEF <50% were recruited to receive sacubitril/valsartan between June 2020 and July 2022.1 Among the 105 validated patients, 20 with systolic blood pressure ≤100 mmHg were further categorized into the low blood pressure cohort, while the remainder (n=85) was considered as non-low blood pressure.1 Echocardiographic assessments were performed before treatment initiation as baseline and 9.5 ± 5.1 months after initiation of the maximum tolerated dose of sacubitril/valsartan as treatment outcome.1  

Primary endpoints:

  • The primary endpoints involved the comparison of LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LVEF between baseline and after treatment initiation for the low blood pressure cohort1
  • A significant reduction in LVEDV from baseline was observed in the low blood pressure cohort (177.3 ± 66.0mL vs. 137.7 ± 56.1mL; p<0.001)1
  • Similarly, a significant reduction in LVESV was achieved after the initiation of sacubitril/valsartan (131.6 ± 60.3mL vs. 94.6 ± 55.7mL; p<0.001)1
  • The median LVEF of the low blood pressure group experienced a 7% improvement after treatment initiation (26.8 ± 10.3% vs. 33.8 ± 13.6%; p=0.015)1

Secondary endpoints:

  • The secondary endpoint included the relative differences from baseline in LVEDV, LVESEV and LVEF between the 2 cohorts1
  • The relative differences from baseline between the 2 cohorts were similar across LVEDV, LVESV and LVEF. No statistically significant difference was observed1


  • Overall, no serious adverse event (SAE) was recorded during the study period1
  • Among the initial patient population (n=164), 10.4% of patients had discontinued treatment due to symptomatic hypotension1
  • Treatment discontinuation rates were numerically higher for the low blood pressure cohort when compared to the non-low blood pressure cohort, but a statistically significant difference was not established (16.0% vs. 9.4%, p=0.320)1


“The findings of our study demonstrated that significant LV reverse remodeling outcomes were achieved in HF patients with LVEF <50% and systolic blood pressure ≤100mmHg after initiation of sacubitril /valsartan”

Dr. Yu Nishihara
Department of Internal Medicine,
Kobe University Graduate School of Medicine,
Kobe, Japan

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