# Systolische bloeddruk bij HFpEF behandeld met sacubitril/valsartan: PARAGON-HF

*geplaatst 2020-04-14 · Hartfalen · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2020.02.009 · https://hartvaat.nl/2020/04/14/systolische-bloeddruk-bij-hfpef-behandeld-met-sacubitril-valsartan-paragon-hf/*

PARAGON-HF analyse naar de relatie tussen systolische bloeddruk en uitkomsten met sacubitril/valsartan bij HFpEF.

## English: Systolic Blood Pressure in Heart Failure With Preserved Ejection Fraction Treated With Sacubitril/Valsartan.

This PARAGON-HF analysis examined the relationship between systolic blood pressure and outcomes with sacubitril-valsartan in HFpEF, informing the blood pressure management strategy in preserved ejection fraction heart failure.

## Abstract (original, from the publication)

BACKGROUND: Guidelines recommend targeting systolic blood pressure (SBP) <130 mm Hg in heart failure with preserved ejection fraction (HFpEF) with limited data. OBJECTIVES: This study sought to determine the optimal achieved SBP and whether the treatment effects of sacubitril/valsartan on outcomes are related to BP lowering, particularly among women who derive greater benefit from sacubitril/valsartan. METHODS: Using 4,795 trial participants, this study related baseline and time-updated mean achieved SBP quartiles (<120, 120 to 129, 130 to 139, ≥140 mm Hg) to the primary outcome (cardiovascular death and total heart failure hospitalization), its components, myocardial infarction or stroke, and a renal composite outcome. At the 16-week visit, the study assessed the relationship between SBP change and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The study analyzed whether the BP-lowering effects of sacubitril/valsartan accounted for its treatment effects. RESULTS: Average age was 73 ± 8 years, and 52% of participants were women. After multivariable adjustment, baseline and mean achieved SBP of 120 to 129 mm Hg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mm Hg (95% confidence interval: 4.4 to 6.0) compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mm Hg) than men (4.0 mm Hg) (interaction p = 0.005). Change in SBP was directly associated with change in NT-proBNP (p < 0.001) but not KCCQ-OSS (p = 0.40). The association between sacubitril/valsartan and the primary outcome was not modified by baseline SBP (interaction p = 0.50) and was similar when adjusting for time-updated SBP, regardless of sex. CONCLUSIONS: Baseline and mean achieved SBP of 120 to 129 mm Hg identified the lowest risk patients with HFpEF. Baseline SBP did not modify the treatment effect of sacubitril/valsartan, and the BP-lowering effects of sacubitril/valsartan did not account for its effects on outcomes, regardless of sex. (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).

Auteurs: Senthil Selvaraj, Brian L Claggett, Michael Böhm, Stefan D Anker, Muthiah Vaduganathan, Faiez Zannad, Burkert Pieske, Carolyn S P Lam, Inder S Anand, Victor C Shi, Martin P Lefkowitz, John J V McMurray, Scott D Solomon

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2020.02.009. Bijgewerkt 2026-07-03T13:27:40Z. 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.