Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System.
J Card Fail. 2023 03; 29(3):258-268.JC

Abstract

BACKGROUND

A substantial proportion of patients with heart failure and kidney disease have poorly controlled blood pressures. This study aimed to evaluate patterns of blood pressure after initiation of an angiotensin receptor neprilysin inhibitor (ARNI) or an angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) across the spectrum of kidney function.

METHODS

Between 2016 and 2020, we evaluated 26,091 patients admitted to a Veterans Affairs hospital for an acute heart failure exacerbation with reduced ejection fraction. We assessed patterns of systolic and diastolic blood pressure among those started on ARNI or ACEI/ARB over 6 months, overall and across estimated glomerular filtration rate (eGFR). To account for differential treatment factors, we applied 1:1 propensity score matching using 15 known baseline covariates.

RESULTS

There were 13,781 individuals treated with an ACEI or ARB and 2589 individuals treated with an ARNI prescription. After propensity score matching, 839 patients were matched in each of the ARNI and ACEI/ARB groups. Mean baseline estimated glomerular filtration rate (eGFR) was 63.8 (standard deviation 21.6), and 10% had stage 4 or 5 chronic kidney disease. Patients in the ARNI group experienced greater systolic blood pressure reduction at month 3 (-5.2 mmHg vs -2.2 mmHg, ARNI vs ACEI/ARB; P < 0.001), and month 6 (-4.7 mmHg vs -1.85 mmHg, ARNI vs ACEI/ARB; P < 0.001). These differences in systolic blood pressure by 6 months did not vary by eGFR above and below 60 mL/min/1.73m2 or continuously across a wide range of eGFR (Pinteraction > 0.10 for both).

CONCLUSION

The use of ARNI was associated with significant reduction in blood pressure as compared to the ACEI/ARB group overall and across the eGFR spectrum, including in advanced chronic kidney disease.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Gjyriqi G

Department of Medicine, Albany Medical College, Albany, NY.

York M

University of South Carolina School of Medicine, Columbia, SC.

Abuazzam F

Nephrology Division, Internal Medicine Department, Loma Linda University School of Medicine & Loma Linda University Health, Loma Linda, CA.

Herzog CA

Cardiology Division, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, MN.

Bangalore S

Cardiology Division, Internal Medicine Department, NYU Grossman School of Medicine, New York, NY.

Lo KB

Internal Medicine Department, Einstein Medical Center, Philadelphia, PA.

Sidhu MS

Cardiology Division, Internal Medicine Department, Albany Medical College & Albany Medical Center, Albany, NY.

Vaduganathan M

Cardiology Division, Internal Medicine Department, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

Rangaswami J

Nephrology Division, Internal Medicine Department, George Washington University School of Medicine, Washington, D.C.

Mathew RO

Nephrology Division, Internal Medicine Department, Loma Linda University School of Medicine & Loma Linda University Health, Loma Linda, CA; Nephrology Division, Internal Medicine Department, Loma Linda VA Healthcare System, Loma Linda, CA.. Electronic address: roy.mathew@va.gov.

MeSH

HumansHeart FailureAngiotensin-Converting Enzyme InhibitorsNeprilysinBlood PressureVeteransAngiotensin Receptor AntagonistsStroke VolumeVentricular Dysfunction, LeftRenal Insufficiency, ChronicKidney

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36516938

Citation

Gjyriqi, Grenita, et al. "Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: an Analysis of the Veterans Administrative Health System." Journal of Cardiac Failure, vol. 29, no. 3, 2023, pp. 258-268.

Gjyriqi G, York M, Abuazzam F, et al. Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System. J Card Fail. 2023;29(3):258-268.

Gjyriqi, G., York, M., Abuazzam, F., Herzog, C. A., Bangalore, S., Lo, K. B., Sidhu, M. S., Vaduganathan, M., Rangaswami, J., & Mathew, R. O. (2023). Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System. Journal of Cardiac Failure, 29(3), 258-268. https://doi.org/10.1016/j.cardfail.2022.10.432

Gjyriqi G, et al. Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: an Analysis of the Veterans Administrative Health System. J Card Fail. 2023;29(3):258-268. PubMed PMID: 36516938.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System. AU - Gjyriqi,Grenita, AU - York,Mikaela, AU - Abuazzam,Farah, AU - Herzog,Charles A, AU - Bangalore,Sripal, AU - Lo,Kevin Bryan, AU - Sidhu,Mandeep S, AU - Vaduganathan,Muthiah, AU - Rangaswami,Janani, AU - Mathew,Roy O, Y1 - 2022/12/11/ PY - 2022/06/15/received PY - 2022/10/19/revised PY - 2022/10/25/accepted PY - 2022/12/15/pubmed PY - 2023/3/21/medline PY - 2022/12/14/entrez KW - Angiotensin receptor neprilysin inhibitor, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, antihypertensive therapy, blood pressure KW - chronic kidney disease, heart failure with reduced ejection fraction SP - 258 EP - 268 JF - Journal of cardiac failure JO - J Card Fail VL - 29 IS - 3 N2 - BACKGROUND: A substantial proportion of patients with heart failure and kidney disease have poorly controlled blood pressures. This study aimed to evaluate patterns of blood pressure after initiation of an angiotensin receptor neprilysin inhibitor (ARNI) or an angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) across the spectrum of kidney function. METHODS: Between 2016 and 2020, we evaluated 26,091 patients admitted to a Veterans Affairs hospital for an acute heart failure exacerbation with reduced ejection fraction. We assessed patterns of systolic and diastolic blood pressure among those started on ARNI or ACEI/ARB over 6 months, overall and across estimated glomerular filtration rate (eGFR). To account for differential treatment factors, we applied 1:1 propensity score matching using 15 known baseline covariates. RESULTS: There were 13,781 individuals treated with an ACEI or ARB and 2589 individuals treated with an ARNI prescription. After propensity score matching, 839 patients were matched in each of the ARNI and ACEI/ARB groups. Mean baseline estimated glomerular filtration rate (eGFR) was 63.8 (standard deviation 21.6), and 10% had stage 4 or 5 chronic kidney disease. Patients in the ARNI group experienced greater systolic blood pressure reduction at month 3 (-5.2 mmHg vs -2.2 mmHg, ARNI vs ACEI/ARB; P < 0.001), and month 6 (-4.7 mmHg vs -1.85 mmHg, ARNI vs ACEI/ARB; P < 0.001). These differences in systolic blood pressure by 6 months did not vary by eGFR above and below 60 mL/min/1.73m2 or continuously across a wide range of eGFR (Pinteraction > 0.10 for both). CONCLUSION: The use of ARNI was associated with significant reduction in blood pressure as compared to the ACEI/ARB group overall and across the eGFR spectrum, including in advanced chronic kidney disease. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/36516938/Angiotensin_Receptor_Neprilysin_Inhibitor_Use_and_Blood_Pressure_Lowering_in_Patients_With_Heart_Failure_With_Reduced_Ejection_Fraction_Across_the_Spectrum_of_Kidney_Function:_An_Analysis_of_the_Veterans_Administrative_Health_System_ DB - PRIME DP - Unbound Medicine ER -

Tags

Angiotensin Receptor Neprilysin Inhibitor Use and Blood Pressure Lowering in Patients With Heart Failure With Reduced Ejection Fraction Across the Spectrum of Kidney Function: An Analysis of the Veterans Administrative Health System.J Card Fail. 2023 03; 29(3):258-268.JC