Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension among PD patients.

Abstract

Purpose: Pulmonary hypertension is an independent risk factor for all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients with heart failure with preserved ejection fraction (HFpEF). However, there is still no effective treatment. The aim of this study is to evaluate the efficacy and safety of sacubitril/valsartan in PD patients with HFpEF and pulmonary hypertension.

Patients and methods: 145 PD patients with HFpEF and pulmonary hypertension receiving sacubitril/valsartan were recruited in this study. 38 PD patients with HFpEF and pulmonary hypertension treated with angiotensin receptor blocker (ARB) were enrolled as the control group. The follow-up time was 3 months. We evaluate efficacy and safety of sacubitril/valsartan through biochemical parameters, and echocardiographic indicators, and adverse reactions.

Results: At the end of follow-up, the pulmonary artery pressure was significantly lower [33.00 (23.00, 45.50) vs 48.00 (40.00, 54.00) mmHg, P < 0.001] after the treatment of sacubitril/valsartan. The percentage change of pulmonary artery pressure after the treatment of sacubitril/valsartan was significantly higher than that of ARB [-30.00 (-48.78, -8.23) vs -8.57 (-12.80, -0.85) %, P < 0.001]. As the biomarkers of heart failure, the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin I were remarkably reduced after the treatment with sacubitril/valsartan. Sacubitril/valsartan can also attenuate left-ventricular remodeling among PD patients. While, ARB does not show significant advantages compared to sacubitril/valsartan.

Conclusion: Our study suggested that sacubitril/valsartan treatment might be an effective treatment for PD patients with HFpEF and pulmonary hypertension.