| ObjectiveTo observe the clinical efficacy and safety of Sacubitril/valsartan dealing with different types of chronic heart failure compared with renin-angiotensin-aldosterone system inhibitors.MethodsA total of 202 patients with chronic heart failure(CHF)were enrolled in this study,which were admitted by Fujian Medical University Provincial College of clinical medicine from October 2018 to August 2019 according to the inclusion and exclusion criteria.Patients were divided into Sacubitril/valsartan group(SV group)(n=102)and renin-angiotensin-aldosterone system inhibitors group(RASI group)(n=100)according to their wishes.Then they were divided into three subgroups: HFrEF,HFmrEF and HFpEF group based on left ventricular ejection fraction(LVEF).All patients were treated with diuretic,aldosterone receptor antagonist,beta blockers and other conventional anti heart failure drugs,SV group were treated with Sacubitril/valsartan(SV),while RASI group were treated with renin-angiotensin-aldosterone system inhibitors(RASI).We followed up patients and filled in the clinical observation table.After 2 weeks,3 months,and 6 months,Systolic blood pressure(SBP),Diastolic blood pressure(DBP),NT-Pro BNP,LVEF,E/e’,left ventricular end diastolic volume(LVEDV),Left ventricular end diastolic diameter(LVEDD)and the occurrence of common adverse reactions such as angioedema,hypotension,impaired renal function and hyperkalemia were recorded.Results1.SV group and RASI group: The basic age,gender,history of smoking,basic illness,the use of drug,creatinine,potassium concentration,SBP,DBP,NT-Pro BNP,E/e’,LVEDV and LVEDD between the two groups were not statistically significant(P>0.05).The basic LVEF in the SV group were significantly lower than that in the RASI group(37.0% vs48.5%).SBP,DBP,NT-Pro BNP,E/e’,LVEDV and LVEDD of each group was significant lower than that before treatment(P<0.001),LVEF was significant higher(P<0.05).The maximum reduction of SBP,DBP and NT-Pro BNP in the SV group was significant greater than that in the RASI group(P <0.05).2.SV-HFrEF group and RASI-HFrEF group:The basic SBP,DBP,NT-Pro BNP,E/e’,LVEDV between the two groups were not statistically significant(P>0.05).The basic LVEF in SV-HFrEF group were significantly lower than that in the RASI-HFrEF group(30.0% vs 34.5%).The basic LVEDD in SV-HFrEF group were significantly longer than that in the RASI-HFrEF group[(6.64±0.93)cm vs(6.17±0.50)cm].SBP,DBP,NT-Pro BNP,E/e’,LVEDV and LVEDD of each group was significant lower than that before treatment(P<0.05),LVEF was significant higher(P<0.05).The maximum reduction of SBP,DBP NT-Pro BNP and LVEDV in the SV-HFrEF group was significant greater than that in the RASI-HFrEF group(P <0.05).3.SV-HFmrEF group and RASI-HFmrEF group:There was no significant difference in baseline information between the two groups(P>0.05).SBP,DBP,NT-Pro BNP,E/e’,LVEDV and LVEDD of each group was significant lower than that before treatment(P<0.05).LVEF in SV-HFmrEF was significant higher than that before treatment(P<0.05).The maximum reduction of SBP,DBP,LVEDV and LVEDD in the SV-HFmrEF group was significant greater than that in the RASI-HFmrEF group(P <0.05).4.SV-HFpEF group and RASI-HFpEF group:There was no significant difference in baseline information between the two groups(P>0.05).SBP,DBP,NT-Pro BNP of each group was significant lower than that before treatment(P<0.05).E/e’ and LVEDD in SV-HprEF was significant lower than that before treatment(P<0.05),LVEF in SV-HFpEF was significant higher than that before treatment(P<0.05).The maximum reduction of SBP in the SV-HFpEF group was significant greater than that in the RASI-HFpEF group(P <0.05).5.Medication safety:There were 7 cases of hypotension in the SV group and 4cases of hypotension in the RASI group.No impaired renal function,angioedema,hyperkalemia were found in the two groups.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions1.SV can reduce blood pressure,NT-proBNP,improve myocardial contractility,diastolic function and ventricular remodeling in CHF.The improvement of SV in blood pressure and NT-pro BNP was better than that of RASI.2.For different types of CHF,SV and RASI can reduce blood pressure,NT-pro BNP,improve myocardial contractility,diastolic function and ventricular remodeling.The improvement of SV in all types’ blood pressure,HFrEF’s NT-pro BNP and Non-HFpEF’s ventricular remodeling was better than that of RASI.3.The medication safety of SV and RASI were consistent. |
PDF Full Text Request