{"id":"fb91ad082dff","type":"article","url":"https://hartvaat.nl/2024/10/29/asymptomatische-versus-symptomatische-hypotensie-bij-sacubitril-valsartan-en-hfr/","title":"Asymptomatische versus symptomatische hypotensie bij sacubitril/valsartan en HFrEF","title_en":"Asymptomatic vs Symptomatic Hypotension With Sacubitril/Valsartan in Heart Failure and Reduced Ejection Fraction in PARADIGM-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.08.012","source_url":"https://doi.org/10.1016/j.jacc.2024.08.012","authors":["Shingo Matsumoto","Li Shen","Alasdair D Henderson","Michael Böhm","Akshay S Desai","Lars Køber","Martin P Lefkowitz","Milton Packer","Jean L Rouleau","Scott D Solomon","Karl Swedberg","Muthiah Vaduganathan","Orly Vardeny","Adriaan A Voors","Michael R Zile","Pardeep S Jhund","John J V McMurray"],"significance":6,"published":"2024-10-29","source_date":"2024-10-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This analysis showed that asymptomatic hypotension during sacubitril-valsartan therapy in HFrEF is common but not associated with worse outcomes, supporting continued ARNI therapy despite low blood pressure readings.","created":"2026-07-03T10:31:16Z","updated":"2026-07-03T13:30:17Z","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 toonde dat asymptomatische hypotensie bij sacubitril/valsartan-gebruik bij HFrEF frequent voorkomt maar niet geassocieerd is met slechtere uitkomsten. Alleen symptomatische hypotensie vereist dosisaanpassing.","abstract_original":"BACKGROUND: Hypotension is an important clinical problem in heart failure (HF). OBJECTIVES: This study sought to examine the association between asymptomatic vs symptomatic hypotension and outcomes in PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). METHODS: In a post hoc analysis of PARADIGM-HF, the efficacy and safety of sacubitril/valsartan compared to enalapril were estimated using time-updated Cox proportional hazards models. The primary outcome was cardiovascular death or HF hospitalization. RESULTS: Among 8,399 patients in PARADIGM-HF, 1,343 (16.0%) experienced only asymptomatic hypotension, and 936 (11.1%) experienced symptomatic hypotension at least once after randomization. Patients with symptomatic hypotension were older and more frequently had cardiovascular comorbidities compared to those developing only asymptomatic hypotension. By contrast, left ventricular ejection fraction was lower in those with asymptomatic hypotension. Patients who experienced either type of hypotension were at higher risk for all outcomes examined. However, the effect of sacubitril/valsartan on the primary outcome was not diminished in patients experiencing hypotension compared to those who did not: the HR for sacubitril/valsartan vs enalapril was 0.80 (95% CI: 0.72-0.89) for no hypotension, 0.87 (95% CI: 0.70-1.08) for asymptomatic hypotension, and 0.51 (95% CI: 0.38-0.69) for symptomatic hypotension (Pinteraction = 0.01), and this was also true for cardiovascular and all-cause deaths. The safety of sacubitril/valsartan vs enalapril was also maintained regardless of the occurrence of hypotension. Discontinuation of randomized treatment was less common with sacubitril/valsartan vs enalapril in patients experiencing asymptomatic and symptomatic hypotension. CONCLUSIONS: Although both asymptomatic and symptomatic hypotension during treatment with sacubitril/valsartan or enalapril were associated with worse outcomes, the benefits of sacubitril/valsartan were maintained (or even enhanced) in patients experiencing hypotension."}