PS-C09-11: THE EFFICACY OF SACUBITRIL/VALSARTAN FOR NONDIPPER AND EXTREME DIPPER HYPERTENSION USING 24 AMBULATORY BP MEASUREMENT

Abstract

Sacubitril/Valsartan increases natriuresis and diuresis and makes superior blood pressure control compared with usual RAS inhibitors. In Japanese clinical cicumstances,ideal blood pressure control to attain BP < 130/80mmHg is difficult for next reasons. 1, Japanese predisposition towards high sodium intake. 2, Salt sensitivity due to Gene Polymorphism. 3, Increasing morbidity of obesity and Metabolic syndrome. 4, Clinical inertia to attain ideal blood pressure control especially in high risk hypertension patients ex. CKD and DM. These high risk patients often suggest nocturnal hypertension by 24 hour ambulatory blood pressure monitoring,24Hr ABPM. Nocturnal hypertension consists of non-dipper pattern, riser pattern, and often associated with cardiovascular event. On the contrary, extreme dipper pattern is sometimes found by24 Hr ABPM and it suggests high systolic BP during daytime in spite of night systolic BP decline. iIt sometimes results in stroke. Therefore antihypertensive therapies to these high risk patients by monitoring only clinic BP are surely insufficient to prevent CVD. Furthermore checking Home BP immediately after wake up is off course necessary, but still inadequate. Without monitoring by 24hr ABPM during nighttime,it is impossible to distinguish between non-dipper pattern, riser pattern and morning surge pattern. Quoting from literature, superiority of Ambulatory over Clinic Blood pressure measurement is proved in predicting mortality,The Dublin Outcome Study. It is essential to check 24hr ABPM to high risk patients. These high risk CKD or DM patients are accompanied by the diminished renal capacity to excrete sodium during daytime and compensate sodium excretion by elevating night blood pressure. This mechanism could be a component of the non dipper or riser pattern. Sacubitril/Valsartan `s effect of natriuresis and diuresis effect could be effective to excrete sodium excretion at daytime and Np makes vasodilatory effect and prohibits of aldosterone production.,and valsartan is anAT1 receptor blockade and prohibits of angiotensin2 effect. Sacubitril/Valsartan is very effective for characteristic “salt sensitive hypertension” Japanese patients. In our clinic, we prescribed 250 patients,120 patients are RAS inhibitor naive, and the rest of130 patients are switched from RAS inhibitor. We present 2 clinical cases prescribing Sacubitril/Valsartan 400 mg every morning and monitored 24hrABPM before and after prescription. 1st case is 48yrs old male, HT, DM and CKD showing non dipper-pattern. 2nd case is 86 yrs female, HT and old cerebral lacuna and left common iliac aneurysma showing extreme dipper pattern. 2 weeks after administration of Sacubitril/Valsartan, 24hr ABPM were checked and non dipper pattern disappeared in Ist patients and extreme dipper pattern disappeared in 2nd case,. Normal circadian rhythms are attained in both patients.