Department of Cardiology, Aichi Medical University.
Department of Cardiology, Nagoya Heart Center.
Int Heart J. 2024;65(4):658-666. doi: 10.1536/ihj.24-065.
Angiotensin receptor-neprilysin inhibitors (ARNI) are effective against heart failure (HF) with reduced ejection fraction, but hypotension is a significant complication. Predictors of ARNI-associated hypotension remain unclear. This study aimed to determine predictors of hypotension after administering an ARNI to patients with HF accompanied by ARNI.This retrospective multicenter observational study analyzed data from 138 consecutive patients with HF treated with an ARNI between August 2020 and July 2021. Hypotension attributed to an ARNI after treatment was defined as (A) systolic blood pressure (SBP) below the 1st quartile ≤ 25 mmHg, and as (B) absolute SBP ≤ 103 mmHg. SBP was measured at baseline, after ARNI treatment, at first follow-up as outpatients and on day 7 for inpatients. Presence of atrial fibrillation, and greater BUN/Cr ratio, and SBP at baseline were significant independent predictors for hypotension after ARNI administration on multivariate analyses. Among 43 patients with AF, fine f-waves on electrocardiograms were significantly more prevalent in the hypotensive group.A robust reduction in blood pressure after ARNI administration is associated with AF and elevated BUN/Cr. This highlights the need for caution when administering ARNI to patients with HF.
血管紧张素受体-脑啡肽酶抑制剂（ARNI）对射血分数降低的心力衰竭（HF）有效，但低血压是一个严重的并发症。ARNI 相关低血压的预测因素仍不清楚。本研究旨在确定 HF 患者接受 ARNI 治疗后发生低血压的预测因素。这项回顾性多中心观察性研究分析了 2020 年 8 月至 2021 年 7 月期间接受 ARNI 治疗的 138 例连续 HF 患者的数据。将 ARNI 治疗后归因于 ARNI 的低血压定义为 (A) 收缩压 (SBP) 低于第 1 四分位数 ≤ 25mmHg，以及 (B) 绝对 SBP ≤ 103mmHg。SBP 在基线时、ARNI 治疗后、门诊第一次随访时和住院第 7 天测量。多变量分析显示，AF 存在、BUN/Cr 比值更高以及基线时 SBP 较高是 ARNI 给药后发生低血压的独立显著预测因素。在 43 例 AF 患者中，低血压组心电图上的精细 f 波明显更常见。ARNI 给药后血压明显下降与 AF 和 BUN/Cr 升高有关。这强调了在 HF 患者中使用 ARNI 时需要谨慎。
