The Roles of Sacubitril/Valsartan in Major Adverse Cardiovascular Events and Renal Function Decline in Hypertensive Patients With Heart Failure

10.6221/AN.202409_38(3).0003

Yee-An Chen；Shuo-Ming Ou

all-cause mortality ； end-stage renal disease ； ischemic stroke ； major adverse cardiovascular events ； sacubitril/valsartan

Acta Nephrologica

38卷3期（2024 / 09 / 01）

153 - 166

英文

BACKGROUND: Several recent studies suggest that sacubitril/valsartan use improves patients' renal function. However, the United Kingdom Heart and Renal Protection-III trial showed no effect of this treatment on kidney function compared with irbesartan; thus, more real-world studies of sacubitril/ valsartan's effects are needed. In addition, most studies in hypertensive patients only focused on reducing blood pressure. None of the studies investigated renal function in hypertensive patients. METHODS: To compare the clinical outcomes of sacubitril/valsartan use and nonuse in hypertensive patients with heart failure. Real-world cohort study in Taiwan. Patients aged ≥ 20 years who were diagnosed with heart failure and hypertension between March 1, 2017, and March 1, 2020, were included. We examined data from 1,916 propensity score-matched sacubitril/valsartan users and controls. Cox regression models and survival analysis were used to compare the outcomes of interest (all-cause mortality, major adverse cardiovascular events and renal adverse outcomes [i.e., end-stage renal disease, ESRD]). The patients were followed until death or the end of the study period. RESULTS: After propensity score matching, a Cox proportional-hazards model showed that sacubitril/valsartan use was associated with lower risks of ESRD (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.50-0.99; P = 0.040) and ischemic stroke (HR, 0.41; 95% CI, 0.26-0.65; P < 0.001). A Kaplan-Meier survival curve revealed that sacubitril/valsartan use was associated with lower risks of ESRD (P = 0.046) and ischemic stroke (P < 0.001). Ejection fraction (EF) changes on cardiograms after sacubitril/valsartan use and a survival curve showed that sacubitril/valsartan use was associated with better EF outcomes (P = 0.040). CONCLUSIONS: Sacubitril/valsartan use decreased the deterioration of renal function and was associated with lower risks of ischemic stroke. It was also associated with EF improvement on transthoracic echocardiograms.