Frecuencia de hipotensión sintomática en pacientes hospitalizados con IC-FEr tratados con ARNI: análisis retrospectivo en un hospital universitario

Introduction: Heart failure with reduced ejection fraction (HFrEF) is one of the leading causes of cardiovascular morbidity and mortality. Treatment with angiotensin receptor-neprilysin inhibitors (ARNIs) has shown benefits in reducing clinical events; however, their use may be associated with adverse effects. Methods: Observational, retrospective, and analytical study conducted at a hospital in Bogotá between January 2023 and January 2024. The study included 100 adult patients with HFrEF (left ventricular ejection fraction <45%) treated with ARNIs, excluding those with a history of hypotension or contraindications to their use. Results: The median age was 68 years, with a male predominance (74%). Orthostatic hypotension occurred in 25% of patients, a frequency higher than that reported in previous clinical studies. Variables significantly associated with adverse effects included baseline potassium levels (p = 0.041), duration of treatment (p = 0.005), and length of hospital stay (p < 0.001). Associations were also observed with decreased glomerular filtration rate, arterial hypertension, and adjustments in the therapeutic regimen. Conclusions: The frequency of symptomatic hypotension was higher than that reported in pivotal studies, especially among patients with comorbidities. These findings highlight the importance of individualizing dosing and closely monitoring vulnerable populations.