PS-C13-14: ARNI DECREASED NIGHTTIME BLOOD PRESSURE EVALUATED BY WRIST-TYPE NOCTURNAL MONITORING DEVICE IN A PATIENT WITH TREATMENT-RESISTANT HYPERTENSION AFTER RENAL DENERVATION

Abstract

Angiotensin receptor-neprilysin inhibitor (ARNI), Sacubitril/Valsartan has been reported to decrease nighttime blood pressure (BP). Moreover, Sacubitril/Valsartan is expected to be useful in treatment resistant hypertension because neprilysin inhibition offers an additional effect to reducing BP levels. In this case report, we observed decreasing nighttime BP by changing from angiotensin-1 receptor blocker (ARB) and hydrochlorothiazide (HCTZ) to Sacubitril/Valsartan in a patient with sustained resistant hypertension despite he had been conducted the procedure of renal denervation. Additionally, we evaluated nighttime BP by newly developed wrist-type nocturnal BP monitoring device, Nightview (Omron HEM9601T, Omron health care, Kyoto, Japan). A 46 year old Asian male, who had underwent renal denervation 8-years ago, suffered for treatment-resistant hypertension despite of administration of multiple antihypertensive medications including combination agent of ARB/HCTZ, Ca-channel antagonist, beta-blocker, alpha-blocker, and mineralocorticoid receptor antagonist. His average of usual daytime (morning and evening) home BP level was 155/85 mmHg. We performed a 7-day consecutive nighttime BP measurement using wrist-type BP monitoring device, which also revealed nocturnal hypertension, 125/65 mmHg. To decrease his daytime or nighttime BP levels, we initiated administration of sacubitril/valsartan 400 mg instead of combination agent of ARB/hydrochlorothiazide (Candesartan 8 mg and Hydrochlorothiazide 6.25 mg). Then, we performed nighttime BP measurements using wrist-type device again, which revealed decreasing nighttime BP to 119/61 mmHg just after initiating Sacubitril/Valsartan instead of combination agent of ARB/HCTZ. His usual daytime home BP also decreased to 140/80 mmHg. Additionally, NT-pro BNP also decreased from 87 to 55 pg/mL. From these observations in this case report, ARNI is expected to improve BP control, especially nighttime BP level, in patients with uncontrolled treatment-resistant hypertension despite multiple drug and denervation therapy. ARNI may be also expected to prevent heart failure in resistant hypertension.