Division of Cardiology, Scripps Prebys Cardiovascular Institute, Scripps Clinic, La Jolla, California, USA.
Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, California, USA.
Clin Cardiol. 2021 Jan;44(1):85-90. doi: 10.1002/clc.23509. Epub 2020 Dec 5.
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.
血管紧张素受体阻滞剂和脑啡肽酶抑制剂（ARNI）的广泛应用仍然很低，由于目前推荐的起始剂量会导致低血压，许多患者无法耐受这种药物。
本研究旨在评估低于标准剂量的 ARNI，沙库巴曲缬沙坦（S/V）是否能显著降低 NT-proBNP，并导致利尿剂剂量、血清钾或肌酐发生任何变化。
在对一家医疗中心的 278 名开始服用低剂量 S/V 的患者进行的回顾性研究中，选择了 45 名患者作为研究对象。将患者分为三组：第 1 组（n = 10）：非常低剂量 S/V（半片 24/26mg 每天两次），第 2 组（n = 10）：非常低剂量滴定至低剂量 S/V，第 3 组（n = 25）：低剂量 S/V（24/26mg 每天两次）。比较 S/V 起始前后 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 1 组：p < 0.01，第 2 组：p < 0.01，第 3 组：p < 0.001）。此外，所有组的利尿剂剂量均显著减少（呋塞米 53mg/天 vs. 73mg/天；p = 0.03），有 17.8%（8/45）的患者能够完全停用利尿剂。血清钾或肌酐无显著变化。
低于标准剂量的 S/V 可显著降低 NT-proBNP 和利尿剂需求，而不改变钾或肌酐，这为那些因低血压而无法耐受 S/V 标准剂量的患者提供了希望，他们可能能够受益于 S/V 治疗。
