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Hemodynamic Effects of Sacubitril-Valsartan Versus Enalapril in Patients With Heart Failure in the EVALUATE-HF Study

2021; Lippincott Williams & Wilkins; Volume: 14; Issue: 3 Linguagem: Inglês

10.1161/circheartfailure.120.007891

1941-3297

Gary F. Mitchell, Scott D. Solomon, Amil M. Shah, Brian Claggett, James C. Fang, Joseph L. Izzo, Cheryl Abbas, Akshay S. Desai, Melvin Martinez-Castrillon, Coral Gables, Jorge Beato, Vipul Shah, Leonard Pianko, Manuel Bouza, Mohsin Alhaddad, Amir Kashani, Gregory Sampognaro, Lloyd Stahl, John J. Lehman, Steve Lebhar, Mark Napoli, Aurelio Torres Consuegra, Humberto Gonzalez, Ramon L. Lloret, M. Kevin Ariani, Masoud Azizad, Anil Shah, David Henderson, John Covalesky, David Brabham, Majed Chane, E. Melado Sánchez, Ramses Vega, Anthony Clay, John McClure, Felix Sogade, Luis E. Ortiz-Muñoz, Todd Lewis, Argentina Gonzalez Zequeira, Rakesh Shah, Norman E. Lepor, Marisela González, Raymond Tidman, Jeffrey S. Berman, David Lorenz, Michele Nanna, Trevor Greene, Edward L. Portnay, Marc Bernstein, Guillermo Somodevilla, Robert Grodman, Mary Kathryn Gaffney, Hyeun Park, Isaac Dor, Shamaila Aslam, Richard Jackson, Guido O. Pérez, Luis Efrén Santos Martínez, Glenn Gandelman, Johnny Dy, Abraham Salacata, Rafik Abadier, John Steuter, Sadeem Mahmood, Harold Betton, Kishor Vora, José Tallaj, Debra F. Weinstein, Hassana Alhosaini, Jason D. Everett, Michael Rosenberg, Stephanie H. Dunlap, Olakunle Akinboboy, J. S. WALIA, Yuly Lyandres, Barry Harris, Wael Abo-Auda, Zebediah A Stearns, Navid Kazemi, Arden Bradley, Lucien Megna, Jeff Taylor, Anthony Innasimuthu, Leslie Waggoner, Denzil Moraes, Sandeep M. Jani, Nicolas Chronos, Nikhil Joshi, M. Judith Radin, Amer Suleman, Paul Grena, Subodh K. Agrawal, Mark Holmberg,

Blood Pressure and Hypertension Studies

Treatment with sacubitril-valsartan reduces mortality and heart failure (HF) events in HF with reduced ejection fraction and may reduce HF hospitalization in women with HF with preserved ejection fraction.EVALUATE-HF randomized 464 participants (109 women) with HF with reduced ejection fraction to sacubitril-valsartan or enalapril for 12 weeks. Documented left ventricular ejection fraction (LVEF) ≤0.40 within the prior 12 months was required, although core laboratory LVEF>0.40 was permitted. Assessments of aortic stiffness (pulse pressure and characteristic impedance, Zc) were performed at baseline and at trough and 4 hours postdose at weeks 4 and 12.In models of change from baseline adjusted for baseline value, treatment with sacubitril-valsartan produced greater overall reductions in mean arterial pressure (treatment group difference, -3.0±0.8 mm Hg, P<0.001) and pulse pressure (-3.0±0.8 mm Hg, P<0.001). Postdose reductions in Zc were greater in the sacubitril-valsartan group (-16±6 dyne×second/cm5, P=0.012). Post hoc analyses found evidence of effect modification by LVEF (interaction P=0.036). With LVEF<0.40, postdose reductions in Zc were greater in the sacubitril-valsartan group (trough, -3±8 dyne×second/cm5 versus post-dose, -17±8 dyne×second/cm5; interaction P=0.024) with no sex difference (treatment×sex interaction, P=0.3). With LVEF≥0.40, treatment with sacubitril-valsartan was associated with greater overall reductions in Zc in women (women, -80±21 dyne×second/cm5 versus men, -20±13 dyne×second/cm5; interaction P=0.019).In prespecified analyses that include pre- and postdose assessments at 4 and 12 weeks, treatment with sacubitril-valsartan was associated with greater postdose reductions in aortic Zc. In a post hoc analysis, sacubitril-valsartan was associated with sustained reductions in Zc in women with LVEF≥0.40. Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02874794.