Department of Cardiology (I), East Hospital, Yantaishan Hospital, Yantai 264000, Shandong, China.
Department of Cardiology (II), The Third People's Hospital of Qingdao, Qingdao University, Qingdao 266041, Shandong, China.
J Healthc Eng. 2022 Feb 18;2022:9494981. doi: 10.1155/2022/9494981. eCollection 2022.
Sacubitril valsartan and valsartan are the first new drugs approved for angiotensin receptor neprilysin lysine inhibitors (ARNIs) in outpatients with chronic heart failure (CHF) and hypertension. Compared with enalapril, sacubitril valsartan and valsartan have been shown to reduce the mortality and morbidity of cardiovascular diseases. However, there is little actual evidence regarding the efficacy of ARNIs in hypertensive patients with CHF.
From January 2019 to January 2021, 60 patients with hypertension and chronic heart failure were diagnosed and treated in our hospital. The patients were randomly divided into an observation group and a control group, with 30 cases in each group. The control group was given valsartan, the observation group was given sacubitril valsartan, and both groups were treated for six months. The endothelium-dependent vasodilation (EDD) function of the brachial artery and serum nitric oxide (NO), endothelin-1 (ET-1), carotid artery intima-media thickness, and glomerular filtration, excess rate (eGFR), and left ventricular ejection fraction (LVEF) were compared between the two groups of patients before and after treatment. The serum adiponectin (APN), matrix metalloproteinase-9 (MMP-9), and brain natriuretic peptide (BNP) levels were compared before and after treatment.
The total effective rate of treatment in the research group was higher than that in the control group ( < 0.05). After treatment, the cardiac function indexes LVESD and LVEDD of the two groups of patients were lower than before treatment, and LVEF was higher than before treatment, and the improvement rate of the treatment group was better than that of the control group ( < 0.05). After treatment, the serum APN of the two groups was higher than before treatment, the levels of MMP-9 and BNP were lower than before treatment, and the improvement rate of patients in the treatment group was better than that of patients in the control group ( < 0.05). There was no statistically significant in the levels of EDD, NO, and ET-1 of the two groups of patients before treatment ( < 0.05). After treatment, compared with the control group, the EDD function and NO level of the research group were significantly increased ( < 0.05), and the level of ET-1 was significantly reduced ( < 0.05). There was no statistically significant difference in carotid artery intima-media thickness, glomerular filtration rate, and left ventricular ejection fraction before and after treatment in the two groups ( < 0.05).
In the treatment of hypertension and chronic heart failure, sacubitril valsartan can improve the clinical symptoms of patients to the greatest extent and can significantly improve the levels of LVEF, LVEDD, NT-proBNP, heart function, and other indicators. Sacubitril valsartan can increase serum APN levels, reduce MMP-9 and BNP levels, and have good clinical effects. Sacubitril valsartan has a protective effect on the vascular endothelial function of patients with hypertension and CHF. However, these results need to be confirmed in studies involving more subjects and require longer follow-up times.
沙库巴曲缬沙坦是全球首个获批的血管紧张素受体脑啡肽酶抑制剂（ARNI），用于治疗慢性心力衰竭（心衰）和高血压。与依那普利相比，沙库巴曲缬沙坦可降低心血管疾病的死亡率和发病率。然而，在高血压合并心衰患者中，ARNI 的疗效证据较少。
2019 年 1 月至 2021 年 1 月，我院收治 60 例高血压合并慢性心力衰竭患者，将患者随机分为观察组和对照组，每组 30 例。对照组给予缬沙坦，观察组给予沙库巴曲缬沙坦，两组均治疗 6 个月。比较两组患者治疗前后肱动脉内皮依赖性舒张功能（EDD）、血清一氧化氮（NO）、内皮素-1（ET-1）、颈动脉内膜中层厚度、肾小球滤过率、滤过率、左心室射血分数（LVEF）。比较两组患者治疗前后血清脂联素（APN）、基质金属蛋白酶-9（MMP-9）、脑钠肽（BNP）水平。
观察组患者的治疗总有效率高于对照组（<0.05）。治疗后，两组患者的左心室收缩末期内径（LVESD）和左心室舒张末期内径（LVEDD）均低于治疗前，左心室射血分数（LVEF）高于治疗前，观察组的改善率优于对照组（<0.05）。治疗后，两组患者的血清 APN 均高于治疗前，MMP-9 和 BNP 水平均低于治疗前，观察组的改善率优于对照组（<0.05）。两组患者治疗前的 EDD、NO 和 ET-1 水平比较，差异均无统计学意义（<0.05）。治疗后，观察组的 EDD 功能和 NO 水平均明显高于对照组，ET-1 水平明显低于对照组（<0.05）。两组患者治疗前后的颈动脉内膜中层厚度、肾小球滤过率和左心室射血分数比较，差异均无统计学意义（<0.05）。
在高血压合并慢性心力衰竭的治疗中，沙库巴曲缬沙坦能最大限度改善患者的临床症状，显著改善 LVEF、LVEDD、NT-proBNP 等心功能指标。沙库巴曲缬沙坦能升高血清 APN 水平，降低 MMP-9 和 BNP 水平，临床疗效较好。沙库巴曲缬沙坦对高血压合并 CHF 患者的血管内皮功能具有保护作用。但这些结果还需要更多的研究对象和更长的随访时间来证实。
