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

Authors

Grenita Gjyriqi, Department of Medicine, Albany Medical College, Albany, NY.
Mikaela York, University of South Carolina School of Medicine, Columbia, SC.
Farah Abuazzam, Nephrology Division, Internal Medicine Department, Loma Linda University School of Medicine & Loma Linda University Health, Loma Linda, CA.
Charles A. Herzog, Cardiology Division, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, MN.
Sripal Bangalore, Cardiology Division, Internal Medicine Department, NYU Grossman School of Medicine, New York, NY.
Kevin Bryan Lo, Internal Medicine Department, Einstein Medical Center, Philadelphia, PA.
Mandeep S. Sidhu, Cardiology Division, Internal Medicine Department, Albany Medical College & Albany Medical Center, Albany, NY.
Muthiah Vaduganathan, Cardiology Division, Internal Medicine Department, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Janani Rangaswami, Nephrology Division, Internal Medicine Department, George Washington University School of Medicine, Washington, D.C.
Roy O. Mathew, 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.

Document Type

Journal Article

Publication Date

12-11-2022

Journal

Journal of cardiac failure

DOI

10.1016/j.cardfail.2022.10.432

Keywords

Angiotensin receptor neprilysin inhibitor, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, antihypertensive therapy, blood pressure; chronic kidney disease, heart failure with reduced ejection fraction

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/1.73m or continuously across a wide range of eGFR (P > 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.

APA Citation

Gjyriqi, Grenita; York, Mikaela; Abuazzam, Farah; Herzog, Charles A.; Bangalore, Sripal; Lo, Kevin Bryan; Sidhu, Mandeep S.; Vaduganathan, Muthiah; Rangaswami, Janani; and Mathew, Roy O., "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" (2022). GW Authored Works. Paper 2116.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2116

Department

Medicine