On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry.
<h4>Background</h4>Achieving target doses of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) is often challenging due to concerns related to hypotension. This study evaluated dose-dependent effects of ARNI considering on-treatment...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0328971 |
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| author | Jiesuck Park Chan Soon Park Tae-Min Rhee Hye Jung Choi Hong-Mi Choi Hyun-Jung Lee Jun-Bean Park Yeonyee E Yoon Seung-Pyo Lee Yong-Jin Kim Goo-Yeong Cho Hyung-Kwan Kim In-Chang Hwang |
| author_facet | Jiesuck Park Chan Soon Park Tae-Min Rhee Hye Jung Choi Hong-Mi Choi Hyun-Jung Lee Jun-Bean Park Yeonyee E Yoon Seung-Pyo Lee Yong-Jin Kim Goo-Yeong Cho Hyung-Kwan Kim In-Chang Hwang |
| author_sort | Jiesuck Park |
| collection | DOAJ |
| description | <h4>Background</h4>Achieving target doses of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) is often challenging due to concerns related to hypotension. This study evaluated dose-dependent effects of ARNI considering on-treatment blood pressure (BP).<h4>Methods</h4>From a multicenter HF registry, 1,097 HFrEF patients receiving ARNI for ≥6 months were stratified into low-dose (<100 mg/day, n = 249) and intermediate-to-high-dose (≥100 mg/day, n = 848) groups. Echocardiographic changes and clinical outcomes were compared across groups, considering on-treatment BP profiles (high-BP ≥ 110 mmHg vs. low-BP < 110 mmHg).<h4>Results</h4>Low on-treatment BP was independently associated with low-dose ARNI use. Both dose groups showed echocardiographic improvement, but the intermediate-to-high-dose group had more pronounced changes. Over 3.1 years (median follow-up), low-dose ARNI use was associated with a higher risk of mortality compared to intermediate-to-high-dose. These trends were consistently observed in both high-BP and low-BP profiles.<h4>Conclusions</h4>Low-dose ARNI use was associated with less improvement in myocardial function and worse clinical outcomes, even in patients with low-BP profiles. This highlights the importance of optimal ARNI dose titration despite low BP concerns. |
| format | Article |
| id | doaj-art-03084fc857f2471496b52812f4d69e83 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-03084fc857f2471496b52812f4d69e832025-08-25T05:31:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01207e032897110.1371/journal.pone.0328971On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry.Jiesuck ParkChan Soon ParkTae-Min RheeHye Jung ChoiHong-Mi ChoiHyun-Jung LeeJun-Bean ParkYeonyee E YoonSeung-Pyo LeeYong-Jin KimGoo-Yeong ChoHyung-Kwan KimIn-Chang Hwang<h4>Background</h4>Achieving target doses of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) is often challenging due to concerns related to hypotension. This study evaluated dose-dependent effects of ARNI considering on-treatment blood pressure (BP).<h4>Methods</h4>From a multicenter HF registry, 1,097 HFrEF patients receiving ARNI for ≥6 months were stratified into low-dose (<100 mg/day, n = 249) and intermediate-to-high-dose (≥100 mg/day, n = 848) groups. Echocardiographic changes and clinical outcomes were compared across groups, considering on-treatment BP profiles (high-BP ≥ 110 mmHg vs. low-BP < 110 mmHg).<h4>Results</h4>Low on-treatment BP was independently associated with low-dose ARNI use. Both dose groups showed echocardiographic improvement, but the intermediate-to-high-dose group had more pronounced changes. Over 3.1 years (median follow-up), low-dose ARNI use was associated with a higher risk of mortality compared to intermediate-to-high-dose. These trends were consistently observed in both high-BP and low-BP profiles.<h4>Conclusions</h4>Low-dose ARNI use was associated with less improvement in myocardial function and worse clinical outcomes, even in patients with low-BP profiles. This highlights the importance of optimal ARNI dose titration despite low BP concerns.https://doi.org/10.1371/journal.pone.0328971 |
| spellingShingle | Jiesuck Park Chan Soon Park Tae-Min Rhee Hye Jung Choi Hong-Mi Choi Hyun-Jung Lee Jun-Bean Park Yeonyee E Yoon Seung-Pyo Lee Yong-Jin Kim Goo-Yeong Cho Hyung-Kwan Kim In-Chang Hwang On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. PLoS ONE |
| title | On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. |
| title_full | On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. |
| title_fullStr | On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. |
| title_full_unstemmed | On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. |
| title_short | On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry. |
| title_sort | on treatment blood pressure and dose dependent effects of arni in heart failure with reduced ejection fraction insights from a multicenter registry |
| url | https://doi.org/10.1371/journal.pone.0328971 |
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