Clinical Observation On The Efficacy Of ARNI Combined With Statins In Elderly Patients With Hypertension And HFpEF

Objective:To observe the clinical effect and changes of observation indicators in elderly patients with hypertension and heart failure with preserved ejection fraction(HFpEF)treated with sacubitril-valsartan(ARNI)combined with statins,It is expected to provide new ideas and reference value for the treatment of HFpEF.Methods:Using the scientific research big data platform of Qingdao University Affiliated Hospital,a total of 375 patients ≥ 65 years old with essential hypertension and HFpEF who were hospitalized in the Department of Cardiovascular Medicine of Qingda Affiliated Hospital from January 2020 to October 2021 were selected.According to the drug regimen,they were divided into ARNI+statin group(group A)with 110 cases,ARNI group(group B)with 60 cases,statin group(group C)with 120 cases,and control group(group D)with 85 cases.Collect basic clinical information of enrolled patients:age,gender,body mass index(BMI),smoking and drinking history,underlying diseases,etc.Laboratory indicators:inflammatory indicators-C-reactive protein(CRP),blood lipid indicators-total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),liver enzyme indicators-alanine aminotransferase(AST),aspartate aminotransferase(ALT),myocardial injury indicator-N-terminal precursor brain natriuretic peptide(NT-proBNP),etc.Collect the patient’s cardiac color Doppler ultrasound indicators.After half a year,the observation indicators were collected,sorted,and counted.The changes of clinical efficacy,pulse pressure,C-reactive protein(CRP),low density lipoprotein(LDL),N-terminal pro-brain natriuretic peptide(NT-proBNP),left atrial volume index(LAVI),left ventricular mass index(LVMI),left ventricular early diastolic maximum mitral flow velocity/early diastolic mitral annular peak velocity(E/e’),and left ventricular ejection fraction(LVEF)were analyzed after treatment.Adverse drug reactions and end events-major adverse cardiovascular events(MACE).The definition of end events included hospitalization due to recurrent heart failure or cardiovascular death.Kaplan-Meier survival curve analysis was used to compare the cumulative survival rates and prognosis of the four groups.Resulsts:1.Compared with ARNI group(group B),statin group(group C)and control group(group D),the total effective rate of ARNI+statin group was significantly different(p<0.05),and the clinical efficacy was significant.2.There was no difference in pulse pressure between groups before treatment.After treatment,ARNI+statin group decreased pulse pressure,which was significantly different from ARNI group(group B),statin group(group C),and control group(group D)(p<0.05).3.There was no difference between the groups before CRP,LDL treatment,and both the ARNI+statin group and the statin group had a good CRP,LDL-lowering effect.Compared with ARNI group(group B)and control group(group D),CRP,LDL decreased,the difference was significant(p<0.05).There was no difference in each group before NT-proBNP treatment.After treatment,ARNI+statin group decreased significantly compared with ARNI group(group B),statin group(group C)and control group(group D),and the difference was significant(p<0.05).4.Before treatment,LAVI,LVMI,E/e’,there was no difference in each group.After treatment,ARNI+statin group decreased significantly compared with ARNI group(group B),statin group(group C),and control group(group D),and the difference was significant(p<0.05).There was little change in LVEF before and after treatment in the four groups,and the difference was insignificant(p>0.05).5.There were no abnormal liver enzymes,renal function and muscle enzymes in the four groups of drug treatment,and no adverse drug reactions were found.The occurrence of end-point events in each group after 6 months of follow-up,there were 3 cases(2.7%)in the ARNI+statin group,4 cases(6.7%)in the ARNI group,5 cases(4.2%)in the statin group,and 10 cases(11.8%)in the control group.Compared with the cumulative survival,the prognosis of the ARNI+statin group was improved,and the difference was significant(p<0.05).Conclusion:1.After treatment in ARNI+statin group,the total clinical effective rate was increased,pulse pressure was reduced and the clinical curative effect was significant.2.The CRP,LDL and NT-proBNP indexes decreased in ARNI+ statin group after treatment,left ventricular remodeling reversed,prognosis improved,and the drug safety was good.