Core Concepts
Sacubitril-valsartan shows greater reduction in natriuretic peptides in HFpEF patients.
Abstract
The PARAGLIDE-HF trial compared sacubitril-valsartan (Entresto) and valsartan (Diovan) in HFpEF patients with an EF >40%. Here are the key highlights and insights:
- Study Details:
- 466 patients with EF >40% enrolled.
- Median age 71, 52% women, 22% Black.
- Primary Endpoint:
- Greater reduction in NT-proBNP with sacubitril-valsartan.
- Secondary Outcomes:
- Favorable outcomes for sacubitril-valsartan.
- Adverse Effects:
- Reduced worsening renal function but increased symptomatic hypotension.
- Subgroup Analysis:
- Larger treatment effect in patients with EF ≤60%.
- Expert Comments:
- Positive outlook on ARNI use in HF patients.
- Editorial Concerns:
- Margin of benefit less than expected.
- Data not conclusive, caution advised in ARNI use.
Stats
The time-averaged reduction in NT-proBNP was greater with sacubitril-valsartan, with a change ratio of 0.85 (15% greater reduction).
Sacubitril-valsartan reduced worsening renal function compared to valsartan (odds ratio, 0.61) but increased symptomatic hypotension (OR, 1.73).
Quotes
"Hopefully, these trial data help strengthen clinicians' resolve to prescribe sacubitril/valsartan to a growing population of vulnerable patients." - Sean Pinney, MD
"Clinicians who elect to use sacubitril-valsartan in this population should be mindful of the risk for hypotension and select patients carefully." - Editorial