What is the permissible low diastolic blood pressure when taking Entresto (sacubitril/valsartan)?

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From the Research

Entresto can be used in patients with low diastolic blood pressure, but caution is advised when diastolic pressure falls below 60 mmHg, as evidenced by the most recent study in 2024 1.

Key Considerations

  • The use of Entresto (sacubitril/valsartan) in patients with heart failure requires careful monitoring of blood pressure, especially in those with low baseline diastolic blood pressure.
  • While there is no absolute minimum diastolic pressure cutoff for Entresto use, healthcare providers typically monitor patients closely if their diastolic pressure is consistently below 60 mmHg.
  • Entresto works by inhibiting both neprilysin and the angiotensin receptor, which can lower blood pressure as part of its therapeutic effect in heart failure.

Dosing and Monitoring

  • When starting Entresto, the recommended approach is to begin with a lower dose (24/26 mg twice daily) in patients with low baseline blood pressure and gradually titrate upward as tolerated.
  • Dose adjustments may be necessary based on individual patient response and symptoms.
  • Patients should report symptoms of hypotension such as dizziness, lightheadedness, or fainting.
  • Regular blood pressure monitoring is essential during Entresto therapy, especially during dose adjustments or when adding other medications that might further lower blood pressure.

Evidence-Based Recommendations

  • The 2024 study 1 found that patients with symptomatic hypotension were older and more frequently had cardiovascular comorbidities compared to those developing only asymptomatic hypotension.
  • The study also found that the benefits of sacubitril/valsartan were maintained (or even enhanced) in patients experiencing hypotension, as evidenced by the hazard ratio for sacubitril/valsartan vs enalapril being 0.80 (95% CI: 0.72-0.89) for no hypotension, 0.87 (95% CI: 0.70-1.08) for asymptomatic hypotension, and 0.51 (95% CI: 0.38-0.69) for symptomatic hypotension (Pinteraction = 0.01).
  • Another study in 2024 2 found that a higher left ventricular ejection fraction (LVEF) was associated with an increased risk of hypotension in patients treated with sacubitril/valsartan compared with valsartan.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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