Yanagawa Tatsuki, Asai Yuki, Zakoji Nobuyuki, Hosoe Shingo, Kondo Yoshihiro, Ootsuki Shinnosuke, Kato Hidekazu, Aoki Maria, Yamamoto Yoshiaki, Yamamoto Takanori, Takahashi Masaaki
National Hospital Organization Mie Chuo Medical Center, Tsu, Mie, 514-1101, Japan.
Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
J Pharm Health Care Sci. 2024 Sep 16;10(1):56. doi: 10.1186/s40780-024-00379-1.
Sacubitril/valsartan is an angiotensin receptor neprilysin inhibitor (ARNI) that inhibits the degradation of endogenous natriuretic peptides. Therefore, ARNIs may increase the efficacy of human atrial natriuretic peptide (hANP), a drug for acute heart failure, by mediating its pharmacological mechanism. This study was aimed at evaluating the effects of ARNIs on the pharmacological effects of hANP by using surrogate marker, such as urinary output, in patients with heart failure.
In this multicenter retrospective cohort study, adult patients with heart failure who were taking angiotensin II receptor blockers (ARB) or ARNIs combined with hANP were enrolled. Information on basic characteristics, clinical laboratory data, medical history, and severity of cardiac insufficiency were collected from electronic medical records. The primary outcome was the change in adjusted fluid balance, calculated by IN-volume (mL/day) - OUT-volume (mL/day) / daily hANP dosage (μg).
Ninety-two and 62 patients in the ARB + hANP and ARNI + hANP groups, respectively, were eligible for analysis. The adjusted fluid balance in the ARNI + hANP group was significantly lower than that in the ARB + hANP group (p = 0.001). After propensity score matching, 27 patients from each group were included. Similarly, there was a significant reduction in adjusted fluid balance in the ARNI + hANP group after propensity score matching (p = 0.026).
These findings suggest that ARNIs may enhance the efficacy of hANP and the combination of the two may be effective in the treatment of heart failure.
沙库巴曲缬沙坦是一种血管紧张素受体脑啡肽酶抑制剂（ARNI），可抑制内源性利钠肽的降解。因此，ARNI可能通过介导其药理机制来增强急性心力衰竭药物人心房利钠肽（hANP）的疗效。本研究旨在通过使用尿量等替代指标评估ARNI对心力衰竭患者hANP药理作用的影响。
在这项多中心回顾性队列研究中，纳入了正在服用血管紧张素II受体阻滞剂（ARB）或ARNI联合hANP的成年心力衰竭患者。从电子病历中收集基本特征、临床实验室数据、病史和心功能不全严重程度等信息。主要结局是通过输入量（mL/天）-输出量（mL/天）/每日hANP剂量（μg）计算得出的调整后液体平衡变化。
ARB + hANP组和ARNI + hANP组分别有92例和62例患者符合分析条件。ARNI + hANP组的调整后液体平衡显著低于ARB + hANP组（p = 0.001）。倾向评分匹配后，每组纳入27例患者。同样，倾向评分匹配后ARNI + hANP组的调整后液体平衡也显著降低（p = 0.026）。
这些发现表明，ARNI可能增强hANP的疗效，两者联合可能对心力衰竭治疗有效。
