Renin profiling predicts neurohormonal response to sacubitril/valsartan.

ESC Heart Failure
Giuseppe VergaroClaudio Passino

Abstract

Clinical trials and observational cohorts show that beneficial effects of sacubitril/valsartan are less strong in an appreciable proportion of patients with heart failure with reduced ejection fraction (HFrEF). Lower blood pressure and impaired renal function predict suboptimal sacubitril/valsartan titration and a less favourable response. Circulating renin encompasses neurohormonal activation, intravascular volume, and renal function. We hypothesized that renin may predict response to sacubitril/valsartan, assessed by changes in N-terminal fraction of pro-brain natriuretic peptide (NT-proBNP). We performed a prospective, open-label, real-life cohort study. The study population consisted of 80 consecutive HFrEF patients (age 66 ± 10 years, 83% men) planned to initiate sacubitril/valsartan. Clinical and biohumoral assessment, including a full neurohormonal panel, was performed at baseline and at 1, 3, and 6 month follow-up. Response to sacubitril/valsartan was defined as ≥30% reduction in NT-proBNP levels from baseline to 6 months. Patients in the lower renin tertile had higher blood pressure and plasma sodium concentration (all P < 0.05). At follow-up, 38 patients (48%) were classified as responders. Circulating renin was lower...Continue Reading

References

Feb 1, 1982·British Heart Journal·T B LevineJ N Cohn
Mar 13, 2010·Journal of Hypertension·Alberto Morganti, UNKNOWN European study group for the validation of DiaSorin LIAISON Direct Renin Assay
May 7, 2011·The American Journal of Cardiology·Giuseppe VergaroClaudio Passino
Mar 31, 2012·International Journal of Cardiology·Roberta PolettiMichele Emdin
Jul 19, 2014·Journal of Cardiovascular Medicine·Giuseppe VergaroRosanna Abbate
Sep 2, 2014·The New England Journal of Medicine·John J V McMurrayUNKNOWN PARADIGM-HF Investigators and Committees
Jun 11, 2016·European Journal of Heart Failure·Orly VardenyUNKNOWN Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF
Feb 21, 2019·Journal of the American College of Cardiology·Michael R ZileJean Rouleau
Jun 15, 2019·Journal of the American College of Cardiology·Giuseppe VergaroMichele Emdin
Nov 8, 2019·Acta Cardiologica·Pieter MartensWilfried Mullens

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