{"id":"be71ed3e5cca","type":"article","url":"https://hartvaat.nl/2017/04/14/systolische-bloeddruk-en-werkzaamheid-van-sacubitril-valsartan-bij-chronisch-hfr/","title":"Systolische bloeddruk en werkzaamheid van sacubitril/valsartan bij chronisch HFrEF","title_en":"Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","answer-hf","bloeddrukbehandeling","bradycardie","hfpef","hfref","sacubitril-valsartan","slaapapneu","supraventriculaire-tachycardie","ventrikelfibrilleren","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw570","source_url":"https://doi.org/10.1093/eurheartj/ehw570","authors":["Michael Böhm","Robin Young","Pardeep S Jhund","Scott D Solomon","Jianjian Gong","Martin P Lefkowitz","Adel R Rizkala","Jean L Rouleau","Victor C Shi","Karl Swedberg","Michael R Zile","Milton Packer","John J V McMurray"],"significance":7,"published":"2017-04-14","source_date":"2017-04-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This analysis examined the relationship between systolic blood pressure and the efficacy and safety of sacubitril-valsartan in HFrEF, providing guidance for prescribing in patients with low or high baseline blood pressure.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de relatie tussen systolische bloeddruk en cardiovasculaire uitkomsten en de werkzaamheid van sacubitril/valsartan bij chronisch hartfalen. Relevant voor bloeddrukmanagement bij ARNI-gebruik.","abstract_original":"BACKGROUND: Compared to heart failure patients with higher systolic blood pressure (SBP), those with lower SBP have a worse prognosis. To make matters worse, the latter patients often do not receive treatment with life-saving therapies that might lower blood pressure further. We examined the association between SBP and outcomes in the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI) with an angiotensin-converting enzyme (ACE) inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF), as well as the effect of sacubitril/valsartan, compared with enalapril, according to baseline SBP. METHODS: We analysed the effect of treatment on SBP and on the primary composite outcome (cardiovascular death or heart failure hospitalization), its components and all-cause death. We examined baseline SBP as a categorical (<110, 110 to < 120, 120 to < 130, 130 to < 140 and ≥140 mmHg) and continuous variable, as well as average in-trial SBP and time-updated SBP. FINDINGS: All-cause and cardiovascular mortality rates were highest in patients with the lowest SBP whereas there was a U-shaped relationship between SBP and the rate of heart failure hospitalization. The benefit of sacubitril/valsartan over enalapril was consistent across all baseline SBP categories for all outcomes. For example, the sacubitril/valsartan versus enalapril hazard ratio for the primary endpoint was 0.88 (95%CI 0.74-1.06) in patients with a baseline SBP <110 mmHg and 0.81 (0.65-1.02) for those with a SBP ≥140 mmHg (P for interaction = 0.55). Symptomatic hypotension, study drug dose-reduction and discontinuation were more frequent in patients with a lower SBP. INTERPRETATION: In PARADIGM-HF, patients with lower SBP at randomization, notably after tolerating full doses of both study drugs during a run-in period, were at higher risk but generally tolerated sacubitril/valsartan and had the same relative benefit over enalapril as patients with higher baseline SBP."}