Effects of Estimated Glomerular Filtration Rate and Systolic Blood Pressure on the Discontinuation of Sacubitril/Valsartan Treatment for Heart Failure

This study aimed to evaluate the effect of systolic blood pressure (SBP) or estimated glomerulus filtration (eGFR) rate on sacubitril/valsartan (S/V) treatment discontinuation. A total of 148 Japanese patients who received S/V treatment for heart failure at Gifu General Medical Center between September 2020 and December 2022 were included. The treatment continuation rate considerably differed between the four groups for eGFR; no difference was observed for SBP. Furthermore, the eGFR and SBP for the risk of S/V treatment discontinuation calculated using the receiver operating characteristic curve were <31.24 mL/min/1.73m2 (specificity: 0.636; sensitivity: 0.748) and <117.5 mmHg (specificity: 0.545; sensitivity: 0.593), respectively, with 0.700 and 0.550 as the area under the curve. Thus, eGFR influenced treatment interruption more than SBP. The influence of eGFR on S/V treatment continuation was verified using the Kaplan–Meier curve because the number of patients with eGFR greater than this cutoff level was 8 of 22 patients who discontinued S/V. The eGFR of ≥45 and <45 groups were 398 (343 – 452) and 505 (465 – 545) days, respectively (P = 0.024). The hazard ratio of each risk factor for discontinuing S/V treatment was calculated using an eGFR of <45. Although only serum chlorine (Cl) levels were detected (hazard ratio: 3.053, P = 0.052), there was no significant difference. Reportedly, long-term S/V treatment for patients with eGFR of <45 mL/min/1.73m2 and Cl of <98 mmol/L should be performed under stricter inspection monitoring.