EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR ON HOME BLOOD PRESSURE AND CARDIAC MARKERS IN HYPERTENSIVE PATIENTS WITH HEART FAILURE

Objective: Sacubitril/valsartan sodium hydrate (hereinafter Entresto) is classified as an ARNI, and is a drug with a mechanism of action that simultaneously inhibits neprilysin (NEP) and angiotensin II (ATII) receptors, suppressing ATII activity and exerting antihypertensive effects. NEP inhibition enhances the action of physiologically active natriuretic peptides (NP), exerting multifaceted effects such as vasodilation, diuresis, urinary sodium excretion, sympathetic nervous system inhibition, and inhibition of cardiac hypertrophy and fibrosis. We investigated home blood pressure, arteriosclerosis index, and cardiac markers in hypertensive patients with heart failure. Design and method: Sixty-two hypertensive patients (mean age 67 years, 32 males, mean number of antihypertensive drugs 3) with chronic heart failure who had been administered an ARB or ACE inhibitor for more than 6 months but had insufficient blood pressure control (home blood pressure systolic 135 or diastolic 85 mmH or more) were switched to Entresto for 12 months, and changes in home blood pressure, BNP, NT-proBNP, hANP, eGFR, echocardiographic indices (EF, LVMI, E/e’), baPWV, and central blood pressure (cSBP) were evaluated. Results: Body weight (BW), BNP, NT-proBNP, hANP, serum K, eGFR, EF, LVMI, E/e’, home morning blood pressure and heart rate, baPWV, and cSBP before Entresto administration were 63±16 kg, 1084±944pg/mL, 1403±1353pg/mL, 1020±631pg/mL, 4.2±0.4mEq/L, 46±14 ml/min/1.73/m2, 51±12%, 139±21 g/m2, 12.1±2.1, 145±12/80±11mmHg, 75±11bpm, 1526±245 cm/sec, and 137±13mmHg, respectively. Twelve months after ARNI administration, BW (-4%), BNP (-39%), NT-proBNP (-34%), LVMI (-15%), E/e’ (-7%), home morning blood pressure (-16/-9mmHg), and baPWV (-4%) significantly decreased (p <0.05). Furthermore, EF (+16%) and hANP significantly increased, while serum K and eGFR did not change. The change in NT-proBNP showed a significant negative correlation with the change in EF and LVFX (r=-0.31, -0.35, respectively), and a significant positive correlation with E/e’ (r=0.30). Conclusions: These results suggest that sacubitril/valsartan may have anti-atherosclerotic effects and reverse cardiac remodeling in addition to its antihypertensive effects in hypertensive patients with chronic heart failure.