Combination Of Valsartan Research Articles

Integrating Metabolomics, Histopathology, and Cardiac Marker Analysis to Assess Valsartan's Efficacy in Mitigating Dasatinib-Induced Cardiac Toxicity in Sprague-Dawley Rats.

Dasatinib (DASA) is associated with cardiotoxic effects, posing risks to patients. Valsartan (VAL) may offer protective benefits against these effects. This study evaluates the impact of DASA, VAL, and their combination on cardiac health. Wistar rats were treated with DASA, VAL, and a combination of VAL and DASA intraperitoneally every other day for 14 days. Body weight and survival rates were monitored. Serum levels of cardiac biomarkers (CPK, LDH, AST) were analyzed. Histopathological and immunohistochemical analyses assessed myocardial architecture and apoptosis-related protein expression. Metabolomic profiling was conducted using GC-MS to identify metabolic changes across treatment groups. The DASA group experienced significant weight loss and a 50% mortality rate, while the combination group had no mortality. Cardiac biomarkers like CPK, LDH, and AST were elevated in the DASA group but significantly reduced in the VAL + DASA group. Histopathological examination showed significant myocardial injury in the DASA group, with improved cardiac tissue morphology in the combination group. Immunohistochemical analysis revealed altered expression of apoptosis-related proteins, including caspase-3 and BCL-2, with improved levels in the combination group compared to DASA alone. Metabolomic profiling identified significant metabolic shifts, with 15 metabolites differentiating the treatment groups, and the VAL + DASA group mitigated the metabolic disturbances caused by DASA. The study suggesting VAL's potential therapeutic role in managing DASA-induced cardiac toxicity. The combination of VAL with DASA not only improved survival rates and reduced cardiac biomarker levels but also preserved myocardial architecture and normalized metabolic profiles. These findings highlight the importance of integrated approaches in evaluating drug efficacy and suggest VAL as a promising candidate for protecting cardiac function in preclinical models of DASA therapy.

Effect of sacubitril and valsartan combined with conventional therapy on patients with heart failure

Purpose: To investigate the clinical effectiveness of the combination of sacubitril and valsartan with conventional therapy in the treatment of patients with heart failure. Methods: This was a retrospective study comprising 100 heart failure patients randomized into study (n = 57) and control groups (n = 43). The study group received sacubitril/valsartan along with conventional drug therapy while control group received only conventional drugs, viz, irbesartan, metoprolol slow release, and furosemide tablets. Echocardiogram showing left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left anterior descending artery (LAD), Nterminal pro-b-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), glomerular filtration rate (eGFR), and homocysteine (HCY) of the two groups were compared before and after treatment. Multiple regression was used to analyze the correlation between re-hospitalization and sacubitril/valsartan intervention. Results: The study group showed significantly lower LVEF, LVESD, LVEDD, LAD, NT-proBNP, and homocysteine levels after treatment compared to control group (p < 0.05). Re-hospitalization for abnormal cardiovascular events between the two groups was significantly different in the adjusted Cox proportional hazards regression model. Furthermore, multiple regression analysis showed that sacubitril/valsartan treatment was the independent variable (p < 0.001). Conclusion: Sacubitril/valsartan improves heart function, with reduced incidence of adverse effects without affecting renal function. Further studies are required to validate these findings by expanding sample size, strictly controlling data quality and strengthening follow-up.

The Combination of Valsartan and Spironolactone Mitigated Mitral Regurgitation-Induced Cardiac Dysfunction in a Novel Rat Model.

Despite its high prevalence, effective treatment for degenerative mitral regurgitation (MR) remains elusive. Although the mineralocorticoid-receptor antagonist spironolactone, in conjunction with renin-angiotensin-aldosterone system inhibitors, has been shown to reduce mortality in patients with heart failure with reduced ejection fraction, its efficacy in managing degenerative MR is uncertain. In this study, we aimed to compare the effectiveness of valsartan (a renin-angiotensin system inhibitor), spironolactone, and combination therapy in mitigating MR-induced myocardial dysfunction. Using a mini-invasive model of degenerative MR, we administered valsartan (31 mg/kg/d), spironolactone (80 mg/kg/d), or a combination of both to rats over a 4-week period. Serial echocardiography and pressure-volume loops were utilized to assess cardiac function and hemodynamics. Rats with degenerative MR treated with valsartan or spironolactone alone did not show significant improvement in myocardial dysfunction. In contrast, combination therapy resulted in significant improvement. Similarly, the pressure-volume relationship was significantly improved in rats treated with the combination therapy compared with that in rats treated with a single therapy. Mechanistically, combination therapy effectively suppressed circulating and cardiac expression of aldosterone- and apoptosis-associated proteins. Overall, combination treatment with valsartan and spironolactone significantly attenuated the degenerative MR-induced myocardial stress and dysfunction, suggesting a potential therapeutic avenue for managing degenerative MR-induced heart failure.

Anti-atrial Fibrillatory and Cardiorenal Protective Effects of the Combination of Valsartan and Cilnidipine in Dahl Salt-Sensitive Rats.

The current study aimed to investigate the anti-atrial fibrillatory (AF) effects of a combination of valsartan and a calcium channel blocker (cilnidipine or amlodipine) in Dahl salt-sensitive (Dahl S) rats. Seven-week-old male Dahl S rats were fed an 8% salt diet. Six weeks later, valsartan (60 mg/kg, Val group), cilnidipine + valsartan (10 + 60 mg/kg, CV group), amlodipine + valsartan (3 + 60 mg/kg, AV group), or vehicle was orally administered daily for 5 weeks. Echocardiography and atrial electrophysiological evaluations were performed on the last day of treatment. Blood pressure in each drug treatment group was lower than in the Vehicle group. The duration of AF induced by atrial burst stimulation was shorter in the Val group (3.2 ± 1.6 s) than in the Vehicle group (11.2 ± 6.0 s), which was further shortened in the CV and AV groups (1.1 ± 0.3 and 1.3 ± 0.3 s, respectively). Left ventricular ejection fraction and left ventricular fractional shortening were greater in the CV and AV groups than those in the Vehicle group. Urinary albumin excretion in the CV group was the lowest among the drug-treated groups. The results collectively suggest that the combination of a calcium channel blocker with valsartan could be useful in terms of its anti-AF action as well as for improving cardiac and renal functions.

Effect of Sacubitril / Valsartan Combination on Abnormal ECG Findings in Patients with Heart Failure with Reduced Ejection Fraction

Abstract Background The mortality rate of patients suffering from choronic heart failure is still high despite advantages in diagnosis and treatment. A new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed, known as angiotensin receptor neprilysin inhibitors (ARNI). Recently, promising data from its administration have demonstrated a decrease in the mortality rate as compared to angiotensin receptor blocker alone. Aim of the Work The aim of this study is to asses effect of Sacubitril/Valsartan combination on abnormal ECG and ECHO parameters in patients with heart failure with reduced ejection fraction as a marker of reverse cardiac remodeling. Patients and Methods Our study was conducted at Ain Shams university hospitals and our target population was heart failure patients with reduced ejection fraction planned to initiate Sacubitril \ Valsartan combination therapy. 100 patients were collected from February 2022 to August 2022. It was an interventional study to follow up the effects of the drug on ECG parameters besides ECHO parameters 6 months after drug initiation. Results We found that in Sacubitril/Valsartan combination therapy there was significant decrease in HR, QRS width and QTc values which reflects the role of this combination to reduce ventricular arrhythmias and preventing SCD. There was significant increase in the EF which was correlated to the significant decrease in QRS width. There was significant improvement in diastolic dysfunction. There was significant decrease in the LA and LV dimensions giving an explanation of the role of the drug in reverse cardiac remodeling. There was significant improvement in NYHA class reflecting the role of the drug in improving quality of life. Conclusion HR, QRS width and QTc were significantly decreased with Sacubitril/Valsartan combination therapy through the follow up period reflecting the effect of the drug on ECG. EF, LA dimension and LVID were improving with Sacubitril/Valsartan combination therapy through the follow up period which give an explanation of the combination therapy for its role in reverse cardiac remodeling. NYHA class of our patients was improving through follow up period which means this drug improves quality of life and reduces hospitalization.

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study.

Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran. This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used. The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications. Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

Development and Validation of Ultra-Performance Liquid Chromatography (UPLC) Method for Simultaneous Quantification of Hydrochlorothiazide, Amlodipine Besylate, and Valsartan in Marketed Fixed-Dose Combination Tablet

Fixed-dose combination therapy is considered a practical approach in the treatment of various diseases, as it can simultaneously target different mechanisms of action that achieve the required therapeutic efficacy through a synergistic effect. A combination of hydrochlorothiazide (HTZ), amlodipine (AMD), and valsartan (VLS) has been created for the treatment of hypertension. Therefore, the aim of this study was to develop an optimized UPLC method for the simultaneous quantification of this combination. A DoE at a level of 32 was used to investigate the effects of column temperature (20, 30, and 40 °C) and formic acid concentration (0.05, 0.15, and 0.25%) on the retention time of each active pharmaceutical ingredient (API), the peak area, and the peak symmetry, as well as the resolution between HTZ-AMD and AMD-VLS peaks. The optimized analytical method was validated and used to extract the three APIs from the marketed product. The optimized analytical condition with a column temperature of 27.86 °C and a formic acid concentration of 0.172% showed good separation of the three APIs in 1.62 ± 0.006, 3.59 ± 0.002, and 3.94 ± 0.002 min for HTZ, AMD, and VST, respectively. The developed method was linear with the LOQ for a HTC, AMD, and VST of 0.028, 0.038, and 0.101 ppm, respectively. Moreover, the developed assay was sustainable and robust, with an RSD % of less than 2%. The application of this method in the extraction of HTZ, AMD, and VST from the Exforge® marketed product showed good separation with a measurable drug content of 23.5 ± 0.7, 9.68 ± 0.1, and 165.2 ± 5.2 mg compared to the label claims of 25/10/160 for HTZ, AMD, and VST, respectively.

Extemporaneous combination therapy with nebivolol/valsartan for the treatment of hypertension: a study of real-world evidence in Europe

Objective To explore real-life use of the extemporaneous combination of nebivolol and valsartan (NV-EXC) in adult hypertensive patients in Europe. Methods Retrospective analysis of patients starting NV-EXC treatment conducted using prescription databases in Italy, Germany, Hungary, and Poland. The selection period during which study patients were identified covered a time span ranging from 3 to 9 years (until 30 June 2020) according to availability of the different data sources. Patient demographics, clinical information, and treatment adherence, measured by proportion of days covered, were evaluated. Additionally, the potential eligibility of Italian patients for the single pill combination (SPC) of nebivolol and valsartan over a one-year period was estimated. Results The study included 170,682 patients initiating NV-EXC across the databases. Most patients were females (from 51 to 60%) and primarily aged over 60 years. Few patients received prescriptions of both available dosages of valsartan (80 and 160 mg) during follow-up (from 3.2 to 8.5%). Common comorbidities included dyslipidemia (19.2%) and diabetes (19.1%). Around 59.5% of patients did not require cardiologic visits during the study period. Adherence to NV-EXC, as indicated by the Italian database, was low in 53.3% of patients, with only 16.1% showing high adherence. The Italian database revealed 680 prevalent NV-EXC users in 2019, estimating a potential 30,222 adult patients eligible for the nebivolol/valsartan SPC. Conclusions The combination of nebivolol and valsartan is frequently prescribed for hypertension, but adherence remains a challenge. A potential nebivolol/valsartan SPC holds promise in enhancing adherence and optimizing therapeutic outcomes for hypertension management.

Infrared Fourier Transform Spectroscopy Method for Analysis of Valsartan and Amlodipine Besylate Combination

This study investigates the analysis of the combination of Valsartan and Amlodipine besylate using the Infrared Fourier Transform and its quantitative calculations by chemometrics based on partial least squares with several variables. A calibration model has been formulated, and absorbance besylate measurements at wave numbers of 1634-1566 cm-1 for valsartan and 1127-1059 cm-1 for amlodipine every 2.0 cm-1. Then simultaneously determine valsartan and amlodipine combined in the tablet preparation. The Infrared Fourier Transform method used for Amlodipine besylate and Valsartan with calibration are y = 13.1317 X -0.0595 and y = 129,731 X - 0.026. The validation parameters is 0.9995, and 0.9999 for R2 values, RMSCEV is 0.02427 and 0.003189, and PRESS is 0.02121 and 0.0003662. Prediction ability was still acceptable and good for determination. The levels result were (101.52±2.74)% and (98.47±5.71)%, and valid with Relative Standard Deviation (RSD) respectively 2%, and average recovery percent obtained in range of 98-102%. The method identified provided guaranteed compliance with USP 43-NF 38 (2020).

Abstract 7187: Entresto protects against doxorubicin-induced cardiotoxicity in mice model of breast cancer

Abstract Doxorubicin (Dox) is a potent chemotherapeutic agent with high efficacy; however, dose-dependent cardiotoxicity undermines its effectiveness in cancer therapies. Entresto, a combination of sacubitril and valsartan (Sac/Val), offers a multi-modal approach. It enhances the beneficial response of the neurohormonal system of the heart while curbing the detrimental effects of the renin-angiotensin-aldosterone system and mitigating further cardiac damage by decreasing sensitivity to natriuretic peptides. The objective of this study is to assess the potential cardioprotective effects of Entresto on doxorubicin-induced cardiotoxicity (DIC) in a mouse model of breast cancer. To achieve this, a syngeneic tumor model of breast cancer was employed. Twenty-five 10-week-old female Balb/c mice were randomly divided into 5 groups: control, Tumor, Tumor + entresto, Tumor + Dox, and Tumor + entresto + Dox. Tumor groups were injected with 4T1 wild-type cells into the mammary fat pad via intraperitoneal injection. Subsequently, after a week, Dox groups were treated with Dox at 8 mg/kg body weight/week for 3 weeks, while control and tumor + entresto received saline. Following Dox treatment, control, and tumor + Dox animals were gavaged daily with saline, while Entresto groups were gavaged with entresto (60 mg/kg) for 3 weeks. Echocardiography assessed cardiac function at baseline and 3 weeks post-DOX treatment. All mice were euthanized at 4 weeks. Our results demonstrated that entresto treatment significantly ameliorated Dox-induced decreases in ejection fraction and fractional shortening while maintaining improved cardiac functions. Entresto also reversed Dox-induced altered levels of cardiac biomarkers (ANP and BNP). Gene and protein expression analyses in heart tissues revealed that entresto modulated the levels of autophagy-related (Beclin-1 and p62), apoptosis-associated (caspase 3 and Bcl-2) and antioxidant-related (Nrf2 and Keap1): genes and proteins expression altered by Dox treatment. Additionally, Entresto attenuated histological evidence of cellular toxicity, apoptosis, and fibrosis in Dox-treated animals with breast cancer. These findings suggest that Entresto confers cardiac protection against DIC in a mouse model of breast cancer without interfering with the antineoplastic effects of Dox. It underscores the potential clinical relevance of Entresto to enhance the safety and efficacy of doxorubicin-based cancer therapies. Citation Format: Abhishek Pandit, Alanna Costas, Biplov Sapkota, Shilpa Thota, Rizwana Begum, Naveen Chintalaramulu, Henry W. Green, Joseph Francis. Entresto protects against doxorubicin-induced cardiotoxicity in mice model of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7187.

Evaluation of the Effectiveness and Efficiency of the Combination of Levamlodipine Besylate and Valsartan in the Treatment of Hypertension

Objective: To investigate the effectiveness and efficiency of combining levamlodipine besylate and valsartan in the treatment of hypertension. Methods: This study selected 28 patients with hypertension as observation subjects. The treatment duration ranged from January 2020 to June 2023. Using the random number table method, patients were divided into two groups. The control group received treatment with valsartan, while the observation group received a combination of valsartan and levamlodipine besylate. Therapeutic effects and safety were compared between the groups, and changes in the patient’s blood pressure and renal function index levels were assessed. Results: The total clinical effective rate of the observation group was significantly higher than that of the control group (P < 0.05). The observation group demonstrated better diastolic blood pressure, systolic blood pressure, and renal function indicators compared to the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: The combined treatment of levamlodipine besylate and valsartan in patients with hypertension showed significant clinical efficacy and holds broad application value.

Effect of combining valsartan and amlodipine in the treatment of type 2 diabetes mellitus complicated by hypertension

Purpose: To investigate the efficacy of combining valsartan and amlodipine on patients who were co-morbid with type 2 diabetes mellitus (T2DM) and hypertension.
 Methods: The medical records of 110 patients treated in North China Electric Power University Hospital, Beijing, China from July 2018 to October 2022 were retrospectively analyzed. Control group (CG; n = 50) was administered oral amlodipine (5 mg daily for 6 months), while the study group (SG; n = 60) received one tablet of co-formulated valsartan (80 mg)) and amlodipine (5 mg) daily for 6 months. All the patients, in addition to the above drugs, were also placed on insulin and atorvastatin calcium. After a 6-month treatment period, the therapeutic effect and incidence of adverse effects were compared between CG and SG. Blood glucose-related indices (glycosylated hemoglobin (HbA1c), 2 h postprandial blood glucose (2 h PG), and fasting blood glucose (FBG)) and blood pressure indices, viz, (diastolic blood pressure (DBP), systolic blood pressure (SBP)) were compared.
 Results: Compared to the pre-treatment values, both groups showed significant decrease in 2 h PG, FBG, HbA1c, SBP and DBP after treatment (p < 0.05), but the 2 h PG, FBG, HbA1c, SBP and DBP in SG were significantly lower in comparison to CG (p < 0.05). The overall response rate (ORR) of CG was significantly lower in comparison to SG (p < 0.05). In SG, there was significant reduction in the incidence of adverse effects compared to CG (p < 0.05).
 Conclusion: The combination of valsartan and amlodipine is effective in treating T2DM co-morbid with hypertension, and satisfactorily controls blood glucose level and blood pressure with a relatively high level of safety. Further experiments would be required to ascertain the reliability of these findings.

Pharmacotherapy for hypertrophic cardiomyopathy

The presented review concerns modern approaches to drug therapy for hypertrophic cardiomyopathy. General issues of the treatment are touched upon, including lifestyle modification, maintaining adequate hydration and avoiding situations that increase obstruction. The role of traditionally used b-blockers and non-dihydropyridine calcium channel blockers in the treatment of the disease is described. Data on the use of disopyramide are presented, the treatment of which allows reducing the obstruction gradient, ameliorating clinical manifestations and improving diastolic function. Special attention is paid to a new class of drugs — cardiac myosin inhibitors: mavacamten and aficamten. The results of randomized clinical trials regarding to evaluating the efficacy of these drugs are reported. The review presents a modern view of the place of perhexiline, trimetazidine, ranolazine, eleclazine, angiotensin II receptor blockers, combination of sacubitril and valsartan in the therapy of hypertrophic cardiomyopathy.

Neprilysin inhibitors and risk of Alzheimer's disease: A future perspective.

Alzheimer's disease (AD) is a heterogeneous neurodegenerative disease with multifaceted neuropathological disorders. AD is characterized by intracellular accumulation of phosphorylated tau proteins and extracellular deposition of amyloid beta (Aβ). Various protease enzymes, including neprilysin (NEP), are concerned with the degradation and clearance of Aβ. Indeed, a defective neuronal clearance pathway due to the dysfunction of degradation enzymes might be a possible mechanism for the accumulation of Aβ and subsequent progression of AD neuropathology. NEP is one of the most imperative metalloproteinase enzymes involved in the clearance of Aβ. This review aimed to highlight the possible role of NEP inhibitors in AD. The combination of sacubitril and valsartan which is called angiotensin receptor blocker and NEP inhibitor (ARNI) may produce beneficial and deleterious effects on AD neuropathology. NEP inhibitors might increase the risk of AD by the inhibition of Aβ clearance, and increase brain bradykinin (BK) and natriuretic peptides (NPs), which augment the pathogenesis of AD. These verdicts come from animal model studies, though they may not be applied to humans. However, clinical studies revealed promising safety findings regarding the use of ARNI. Moreover, NEP inhibition increases various neuroprotective peptides involved in inflammation, glucose homeostasis and nerve conduction. Also, NEP inhibitors may inhibit dipeptidyl peptidase 4 (DPP4) expression, ameliorating insulin and glucagon-like peptide 1 (GLP-1) levels. These findings proposed that NEP inhibitors may have a protective effect against AD development by increasing GLP-1, neuropeptide Y (NPY) and substance P, and deleterious effects by increasing brain BK. Preclinical and clinical studies are recommended in this regard.

UV Spectrophotometry with Chemometric methods for Concurrent Assays of Antihypertensive Components in Tablets

Chemometrics is the precise and practice of analyzing data through various numerical techniques in order to develop useful information. Generally, it is better to measure many nonselective signals and then combine them in a multivariate model. Nowadays, the combinations of amlodipine, valsartan, and hydrochlorothiazide are effective antihypertensive drugs. The combination of active ingredients will be evaluated for its component content and validated using the chemometric spectrophotometric method paired with the multivariate partial least squares system. For modeling calibration and chemometric validation, a double divisor system was employed. An ultraviolet spectrophotometric measurement was performed by measuring the absorbance spectrum at a wavelength of 230-300nm of AML, 220-290nm of valsartan, and 230-300nm of hydrochlorothiazide at 2nm intervals. Partial Least Squares were used to calculate levels of AML is (99.59±0.28)%; VAL is (101.99± 0.44)% and HCT is (103.60±0.34)% and cross-validated using R2, PRESS, and RMSCEV. Concluded that the determination of amlodipine, valsartan, and hydrochlorothiazide mixtures by the partial least squares multivariate chemometric method met the requirements for tablet dosage forms, according to USP 43-NF38.

Efficacy of the combination of valsartan and hydrochlorothiazide in the treatment of hypertensive heart disease

Purpose: To investigate the effectiveness of the combination of valsartan and hydrochlorothiazide in managing hypertensive heart disease.Methods: From August 2020 to October 2022, the case data of 120 patients in Lu’an Hospital of Anhui Medical University, Lu’an, China were analyzed retrospectively. Based on the different treatment options, 54 patients with hypertensive heart disease who received valsartan alone (80 mg, once daily) for 3 months were placed in control group (CG), while 66 patients who received valsartan combined with Systolic blood pressure (SBP), therapeutic effect, diastolic blood pressure (DBP), and incidence of adverse effects were also recorded for CG and SG.Results: In the SG, there were significant reductions in SBP, DBP, LVMI and LVPWT compared to CG, while EF showed significant increase after treatment (p < 0.05). In both groups, SBP, DBP, LVMI and LVPWT decreased significantly after treatment compared to pre-treatment values, but EF however showed a significant increase (p < 0.05). In the SG, there was a significant increase (p < 0.05) in the total effective rate compared to CG and there was also a significant reduction (p < 0.05) in the total incidence of adverse effects compared to CG.Conclusion: Valsartan combined with hydrochlorothiazide is more effective in treating patients with hypertensive heart disease than valsartan monotherapy alone. However, the combination treatment should be subjected to further clinical trials prior to its introduction into clinical practice.

Role of Combination of Sacubitril and Valsartan for Management of Patients with Decompensated Heart Failure

Role of Combination of Sacubitril and Valsartan for Management of Patients with Decompensated Heart Failure

Role of Combination of Sacubitril and Valsartan for Management of Patients with Decompensated Heart Failure

Role of Combination of Sacubitril and Valsartan for Management of Patients with Decompensated Heart Failure

Impact of Sacubitril/Valsartan Combination on Prevalence of Arrhythmia in Heart Failure Patients with Reduced Ejection Fraction

Abstract Aim and Objectives The aim of this study was to assess the effect of Sacubitril/Valsartan combination on prevalence of arrhythmias in HFrEF patients and compare it with patients on ACEI or ARBs only in addition to echo parameters follow up. Patients and Methods This study was conducted at Ain Shams university and Nasr city insurance hospitals and our target population was heart failure patients with reduced ejection fraction on either Sacubitril\Valsartan combination therapy (Group A) or on ACEI or ARBs (Group B) for at least 3 months, it was an observational study to follow up the burden of arrhythmia among heart failure patients by 48 hours holter monitoring at 3 and 6 months besides Echo parameters follow up. Results Our study included 2 groups. Group A (30 patients on Sacubitril/Valsartan combination therapy and mean age was 58.23 ± 4.80 years, 73.3% of patients were males and 26.7% females). Group B (30 patients on ACEIs or ARBs with mean age 56.37 ± 4.49 years, 80.0% of patients were males and 6 % females). There was no significant difference regarding the medical history, risk factors and NYHA classification of heart failure. The patients were classified into ischemic and non-ischemic cardiomyopathy patients and there was no significant difference between both groups. Group A was characterized by significant decrease in QTc values which reached the lowest values after 6 months, in the opposite side; group B was associated with increasing QTc values through the follow up period. As regards echocardiographic parameters we have found that left ventricle ejection fraction was improving to reach the highest values after six months in group A but we did not find significant improvement of left ventricle ejection fraction in group B. Other echocardiography parameters in group A including LA, LVIDd, RVSP and SWMA were improved by the end of the study but we have found that LA diameter was increasing in group B. In group A, burden of ventricular ectopics was found to be decreasing through the follow up period but there was no significant change of ventricular ectopics incidence in group B by the end of the study. Conclusion Sacubitril/Valsartan combination therapy was superior to ACEIs in reducing ventricular ectopics which means that this drug plays a role in preventing SCD. Ejection fraction in Sacubitril/Valsartan combination group was improving through the follow up period. Echocardiographic parameters were improving in Sacubitril/Valsartan group as regard LA, LVIDd and RVSP. Functional capacity in Sacubitril/Valsartan combinations group was improving through follow up period which means this drug reduces hospitalization.

DIFFERENT METHODS OF ADHERENCE TO THERAPY IN PATIENTS WITH RESISTANT HYPERTENSION (PILOT STUDY)

Poor adherence to treatment is one of the reasons for not reaching the target levelof blood pressure and the consequences in the form of the development of cardiovascularcomplications.Aim – to analysis adherence to treatment of patients with resistant arterial hypertensionby various methods and to determine ways to overcome non-adherence to treatment.Material and methods. 12 patients with resistant hypertension were included into the study.Men and women over the age of 18 were included, provided that the average level of officeblood pressure was greater than 140/90 mm Hg when taking 3 or more antihypertensivedrugs included with fixed combination of valsartan, amlodipine, hydrochlorotiazide. Todetermine adherence to treatment, questionnaires and determination of drugs in urinewere performed in the central laboratory using the chromatography method. All patientsunderwent the following studies at the beginning: measurement of office SBP, DBP, andheart rate. The duration of observation was 12 months.Results. The average age of the patients was 58,67±13,68 years. Men and women –50 %/50 % (n=6/6). The degree of decrease in office blood pressure after 12 monthsof treatment was for SBP/DBP – 35.5/16.7 mm Hg, (p <0.001 for both values) againsta background of a fixed triple combination of valsartan/amlodipine/hydrochlorothiazide.According to the determination of drugs in the urine, we found that 25 % of patients(n=3) did not take drugs at all. The result of the survey showed the need to increase the awareness of patients about the symptoms of the disease. Survey data indicate the needto clarify the necessity to ensure continuous, long-term self-monitoring of blood pressureand taking antihypertensive drugs by keeping a diary in order to improve adherence andeffectiveness of treatment.Conclusion. In 25 % of patients with resistant arterial hypertension, drugs were notdetected in the urine at all, that is, they were nonadherence to therapy.