PS-R01-5: SACUBITRIL/VALSARTAN IMPROVES HYPERTENSION, NIGHTTIME BLOOD PRESSURE AND HEART FAILURE: A CASE-REPORT

Abstract

Objective: Sacubitril/valsartan, angiotensin receptor blocker (ARB)/neprilysin inhibitor, has been shown to effectively reduce ambulatory 24-h blood pressure in patients with hypertension. Improvements in heart failure have also been reported. This case report highlights the validity of sacubitril/valsartan for the treatment of hypertension, nocturnal blood pressure, and heart failure. Methods: A 75-year-old hypertensive male patient with heart failure was prescribed an ARB and a β;-blocker, along with a mineralocorticoid receptor antagonist (MRA) for diuresis. However, his nighttime blood pressure and central blood pressure remained high, and left ventricular ejection fraction (LVEF) remained low, along with persistent elevation of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels. Hence, we switched the ARB to sacubitril/valsartan. The other drugs were left unchanged. We measured his daytime and nighttime blood pressure by ambulatory blood pressure monitoring (ABPM) before and 6 months after the change of medication. In addition, central systolic blood pressure (cSBP) was measured using an automated tonometry system, LVEF, left ventricular mass index (LVMI), left atrial (LA) diameter and septal ratios of transmitral flow velocity to annular velocity (septal E/e’ ratio) were measured using a Vivid S6 ultrasound system with 3-MHz transducer and serum sample was obtained for NT-pro BNP assessment before and 6 months after the change of medication. Results: Brachial blood pressure (154/71 to 132/72 mmHg), nocturnal blood pressure (average value: 136/65 to 121/67 mmHg), and cSBP (154 to 135 mmHg) improved by changing the treatment. Additionally, the riser pattern was improved to the dipper blood pressure pattern by changing the prescription, along with improvements in EF (39.5 to 51.2%), LVMI (127.3 to 119.6 g/m2), LA diameter (40.1 to 37.8 mm) and septal E/e’ ratio (15.1 to 14.5). Further, although serum levels of NT-pro BNP improved with the change of treatment (656 to 325 pg/mL). Symptoms of heart failure were also reduced from New York Heart Association (NYHA) class 3 to NYHA class 2. There were no noticeable adverse effects after the change. Conclusion: In our patient, changing from an ARB to sacubitril/valsartan resulted in an improvement in nighttime and central blood pressure, and left ventricular hypertrophy and diastolic function, and to recovery of EF, with a change from heart failure with reduced ejection fraction (HFrEF) to heart failure with preserved ejection fraction (HFpEF). His NT-proBNP levels and heart failure symptoms also improved. Our experience suggests that sacubitril/valsartan might be useful in patients with heart failure who have nocturnal hypertension.