| Objective(s): To investigate the efficacy and safety of sacubitril-valsartan(ARNI)in patients with chronic heart failure with reduced ejection fraction(LVEF≤40%)at different blood pressure levels.Methods: From January 2020 to December 2021,100 cases with reduced ejection fraction(HFr EF≤40%)were enrolled in the Department of Cardiology of Kunming First People’s Hospital(South Campus),and were divided into 2 groups according to their systolic blood pressure,50 cases of systolic blood pressure ≥110mm Hg in the control group and 50 cases with systolic blood pressure < 110 mm Hg in the experimental group.The two groups were followed up in January,March and June,and a database was established to record the changes of NT-Pro BNP and cardiac ultrasound indexes: left ventricular ejection fraction,left ventricular end-systolic inner diameter,left ventricular end-diastolic inner diameter,creatinine,endogenous creatinine clearance,blood potassium,blood sodium,systolic blood pressure,diastolic blood pressure and other indicators.SPSS26.0 software was used to statistically analyze the relevant data.Through intra-group comparison before and after treatment and between experimental group and control group,the efficacy of ARNI in patients with heart failure with low blood pressure was evaluated by the changes of NT-Pro BNP,left ventricular ejection fraction,left ventricular end-systolic inner diameter and left ventricular end-diastolic inner diameter in January,March and June after treatment.By assessing the change in New York cardiac function grade after 6months of treatment,New York cardiac function grade 2 or above or cardiac function improvement of more than 1 grade was considered effective,and still grade III,IV and worsening cardiac function after medication were considered ineffective.Changes in creatinine,endogenous creatinine clearance,potassium,sodium,systolic blood pressure,diastolic blood pressure and other indicators.To assess the safety of ARNI in patients with heart failure with reduced ejection fraction and low blood pressure.After6 months of treatment,the New York cardiac function grade improved in the two groups,and the effective rate was performed for binary logistic regression analysis.Results: 1.Compared with the two groups before and after oral ARNI treatment,(1)In terms of NT-pro BNP,the two groups were significantly reduced after treatment at 3 months and 6 months,and the difference was statistically significant(P<0.05),and there was no significant difference between the groups(P>0.05).(2)In terms of LVEF,the two groups of patients had significant improvements compared with the baseline after treatment for 1,3 and 6 months(P<0.05).The LVEF in the experimental group before treatment was lower than that in the control group(P<0.05),and there was no significant difference in the rest.2.Comparison between the two groups before and after oral ARNI treatment,(1)In terms of left ventricular end-systolic inner diameter,the left ventricular end-systolic inner diameter of the control group was significantly reduced compared with before treatment in 1 month and 6 months after treatment(P<0.05).In the experimental group,the left ventricular end-systolic inner diameter was significantly reduced 6months after treatment compared with before treatment(P<0.05).Before treatment,the left ventricular end-systolic inner diameter of the experimental group was significantly greater than that of the control group(P<0.05).There were no significant differences between the remaining groups(P>0.05).(2)In terms of left ventricular end-diastolic inner diameter,the control group significantly decreased the left ventricular end-diastolic inner diameter in 3 months and 6 months after treatment compared with before treatment(P<0.05).In the experimental group,the left ventricular end-diastolic inner diameter was significantly reduced 6 months after treatment compared with before treatment(P<0.05).There was no statistically significant difference between groups(P>0.05).3.Compared with the two groups of patients before and after oral ARNI treatment,there was no significant difference between the two groups in terms of creatinine and endogenous creatinine clearance after treatment for 1,3 months and 6 months(P>0.05).There was also no statistically significant difference between groups(P>0.05).4.Comparison between the two groups before and after oral ARNI treatment,(1)In terms of serum potassium,there was no significant difference between the two groups after treatment for 1 month,3 months and 6 months(P>0.05).After 6 months of treatment,the serum potassium of the experimental group was lower than that of the control group(P<0.05).(2)In terms of serum sodium,there was no significant difference between the two groups after treatment for 1 month,3 months and 6months(P>0.05).Compared between groups,serum sodium in the experimental group before treatment was lower than that in the control group(P<0.05).5.Comparison between the two groups before and after oral ARNI treatment,(1)In terms of systolic blood pressure,the average value of the control group before treatment was 130.84±15.63 mm Hg,which decreased to 118.29±17.31 mm Hg after 1month of treatment,which decreased by 12.55 mm Hg(P<0.05)compared with before treatment.After 3 months and 6 months of treatment,systolic blood pressure tended to be stable,and the mean systolic blood pressure was lower than that before treatment(P<0.05).The mean pre-treatment average of 97.80±8.49 mm Hg in the experimental group increased to 104.68±14.70 mm Hg after treatment,an increase of6.88 mm Hg(P<0.05).After 3 months and 6 months of treatment,systolic blood pressure stabilized,and the mean value was greater than that before treatment(P<0.05).(2)In terms of diastolic blood pressure,the average value of the control group before treatment was 86.11±16.79 mm Hg,which decreased to74.67±13.72 mm Hg after 1 month of treatment,which decreased by 11.44 mm Hg(P<0.05)compared with before treatment.After 3 months and 6 months of treatment,systolic blood pressure stabilized,and the mean number was lower than that of diastolic blood pressure before treatment(P<0.05).There was no significant difference in diastolic blood pressure between the experimental group after 1 month,3months and 6 months of treatment compared with the baseline before treatment(P>0.05).6.Subgroup analysis: Binary logistic regression analysis of effective rate for improvement of cardiac function grading in New York after 6 months of treatment,baseline systolic blood pressure(P = 0.015,OR = 1.196,OR95%CI: 1.035,1.382)ARNI titration was the largest(P = 0.006,OR = 1.042,OR95%CI: 1.012,1.073)was statistically significant for the improvement of New York cardiac function grade(P<0.05),and the remaining variables were not statistically significant(P>0.05).The largest amount of ARNI titration in the experimental group(P = 0.033,OR =1.013,OR95% CI: 1.001,1.025)was statistically significant for the effective rate of improvement of New York cardiac function grade(P<0.05),while the remaining variables were not statistically significant(P>0.05).Conclusion(s): 1.Oral ARNI therapy can improve cardiac function,reverse ventricular remodeling,and delay the progression of heart failure,whether it is a patient with low blood pressure or a patient with relatively high blood pressure.2.The treatment of sacubitril valsartan reduces ejection fraction and the treatment of heart failure is timely.3.Whether it is low blood pressure,heart failure patients or relatively high blood pressure heart failure patients,oral ARNI treatment has little effect on kidney function,blood potassium and blood sodium,and has high safety.4.The initial dose of ARNI in patients with low ejection fraction and low blood pressure heart failure is 25 mg bid,and the titration is carried out gradually,which is safe and effective,and can improve the function of the heart pump and increase systolic blood pressure. |
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