Hypotension induces intolerance to sacubitril/valsartan

Treatment with sacubitril/valsartan is well tolerated in most patients with heart failure with reduced ejection fraction (HFrEF), a recent study has found. For others who are intolerant, hypotension is the usual culprit.

“Sacubitril/valsartan has been shown to improve outcomes in patients with HFrEF, [but] initiation of sacubitril/valsartan has primarily been studied in stable, ambulatory patients with HFrEF,” the researchers said.

To determine the risk factors for intolerance to inpatient sacubitril/valsartan initiation, a retrospective, single-centre study was conducted from 1 August 2015 to 30 April 2018. Patients were eligible if they were at least 18 years old and newly initiated on sacubitril/valsartan during their hospitalization.

Of the 143 patients who met the eligibility criteria, 29 (20.3 percent) were intolerant to inpatient initiation of sacubitril/valsartan. Hypotension (n=19, 65.5 percent) was the most common reason for intolerance. On the other hand, those with recent diagnosis of heart failure were more likely to tolerate the initiation of sacubitril/valsartan (32.5 percent vs 10.3 percent; p=0.03).

Furthermore, no between-group differences were observed among other potential predictors for intolerance to sacubitril/valsartan, such as systolic blood pressure, acutely decompensated heart failure, or serum creatinine. Of note, hypotension also happened to be the most common adverse events, occurring in 38 (26.6 percent) of patients.

“Larger prospective, randomized controlled trials would be helpful in further determining ideal candidates for inpatient sacubitril/valsartan initiation,” the researchers said.