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Reduced loop diuretic use in patients taking sacubitril/valsartan compared with enalapril: the PARADIGM-HF trial

Artikel i vetenskaplig tidskrift
Författare O. Vardeny
B. Claggett
J. Kachadourian
A. S. Desai
M. Packer
J. Rouleau
M. R. Zile
Karl Swedberg
M. Lefkowitz
V. Shi
J. J. V. McMurray
S. D. Solomon
Publicerad i European Journal of Heart Failure
Volym 21
Nummer/häfte 3
Sidor 337-341
ISSN 1388-9842
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 337-341
Språk en
Länkar dx.doi.org/10.1002/ejhf.1402
Ämnesord Diuretics, Randomized clinical trial, Heart failure with reduced ejection fraction, Sacubitril/valsartan, Enalapril, progressive heart-failure, death, hospitalization, inhibition, neprilysin, mortality, system, Cardiovascular System & Cardiology
Ämneskategorier Kardiologi

Sammanfattning

Aims To assess differences in diuretic dose requirements in patients treated with sacubitril/valsartan compared with enalapril in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial. Methods and results Overall, 8399 patients with New York Heart Association class II-IV heart failure and reduced LVEF were randomized to sacubitril/valsartan 200 mg bid or enalapril 10mg twice daily. Loop diuretic doses were assessed at baseline, 6, 12, and 24months, and furosemide dose equivalents were calculated via multiplication factors (2x for torsemide and 40x for bumetanide). Percentages of participants with reductions or increases in loop diuretic dose were determined. At baseline, 80.8% of participants were taking any diuretics (n = 6290 for loop diuretics, n = 496 for other diuretics); of those, recorded dosage data for loop diuretics were available on 5487 participants. Mean baseline furosemide equivalent doses were 48.2mg for sacubitril/valsartan and 49.6mg for enalapril (P = 0.25). Patients treated with sacubitril/valsartan were more likely to reduce diuretic dose and less likely to increase diuretic dose relative to those randomized to enalapril at 6, 12, 24 months post-randomization, with an overall decreased diuretic use of 2.0% (P = 0.02), 4.1% (P < 0.001), and 6.1% (P < 0.001) at 6, 12, and 24months, respectively, with similar findings in an on-treatment analysis. Conclusion Treatment with sacubitril/valsartan was associated with more loop diuretic dose reductions and fewer dose increases compared with enalapril, suggesting that treatment with sacubitril/valsartan may reduce the requirement for loop diuretics relative to enalapril in patients with heart failure with reduced ejection fraction.

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