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.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: December 10, 2022
Accepted:
October 25,
2022
Received in revised form:
October 19,
2022
Received:
June 15,
2022
Albany and New York, New York; Columbia, South Carolina; Loma Linda, California; Minneapolis, Minnesota; Philadelphia, Pennsylvania; Boston, Massachusetts; and Washington, D.C.Identification
Copyright
Published by Elsevier Inc.
