Implications of asymptomatic hypotension for patients prescribed sacubitril/valsartan: Insight from the REVIEW-HF registry.

Abstract

Background: Sacubitril/valsartan has unequivocally demonstrated prognostic improvement in patients with chronic heart failure in large-scale randomized controlled trials. However, it remains uncertain whether patients presenting with asymptomatic hypotension have distinct prognoses compared to those with symptomatic hypotension, and there is no consensus on the optimal strategy for managing asymptomatic hypotension.

Methods and results: A multicenter retrospective study was conducted, analyzing data from patients initiated on sacubitril/valsartan therapy. The primary outcome was a composite of cardiovascular death or a hospitalization for heart failure. Among 992 patients, 72 patients (7.3 %) experienced symptomatic hypotension, and 122 patients (12.3 %) experienced asymptomatic hypotension within three months. The incidence of primary endpoint for patients who experienced hypotension, regardless of whether it was symptomatic or asymptomatic, was higher than for those who did not experience hypotension (Log-rank p < 0.05). Among patients who experienced asymptomatic hypotension, 23 patients discontinued sacubitril/valsartan within three days after the onset of asymptomatic hypotension. Patients who discontinued sacubitril/valsartan after the occurrence of asymptomatic hypotension experienced a significantly higher incidence of primary endpoints compared to those who continued sacubitril/valsartan therapy (Log-rank p = 0.01).

Conclusion: The prognosis of patients who discontinued sacubitril/valsartan after the occurrence of asymptomatic hypotension during sacubitril/valsartan therapy was poor. It may be beneficial to aim for the continuation of sacubitril/valsartan therapy even after the occurrence of asymptomatic hypotension.