Physicians' Academy for Cardiovascular Education

Low baseline SBP associated with higher mortality in HF patients

Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF

Literature - Böhm M, Young R, Jhund PS, et al. - Eur Heart J. 2017; published online ahead of print


Heart failure combined with low systolic blood pressure (SBP) is associated with poor outcomes. Therefore, therapies that improve prognosis but lower blood pressure further are avoided in such patients [1-3]. In the PARADIGM-HF study, in which heart failure patients with reduced ejection fraction were randomised to receive either the ACE inhibitor enalapril 10 mg twice daily or sacubitril/valsartan 97/103 mg twice daily, sacubitril/valsartan reduced the primary composite endpoint of cardiovascular (CV) death or heart failure hospitalisation by 20% compared with enalapril [4,5].

Sacubitril/valsartan lowers blood pressure more than ACE inhibitors or ARBs do. The present analysis of the PARADIGM-HF study (n=8399) was conducted, in order to assess the efficacy and safety of sacubitril/valsartan compared with enalapril, according to baseline SBP, SBP 4 months after randomisation and SBP over whole follow-up. For this purpose, SBP was categorized as <110mmHg, 110 to <120mmHg, 120 to <130mmHg, 130 to <140mmHg and ≥140mmHg. Primary composite endpoint was CV death or heart failure hospitalization.

Main results


Although at higher risk for all-cause mortality, CV mortality and heart failure hospitalisation, heart failure patients with reduced ejection fraction of the PARADIGM-HF study with low SBP at baseline and on sacubitril/valsartan had the same relative benefit over enalapril as patients with higher baseline SBP. However, hypotension-related adverse effects were more often observed in the sacubitril/valsartan arm.


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Find this article online at Eur Heart J

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