Objective To observe the clinical efficacy and safety of sacubitril-valsartan in patients with reduced ejection fraction and hypotensive heart failure. Methods A total of 100 patients with decreased ejection fraction combined with hypotension and heart failure who were admitted to the Department of Cardiology of Kunming First People’ s Hospital from January 2020 to December 2021 were included in the study. The patients were randomly divided into an observation group and a control group, with 50 cases in each group. The patients in the two groups were given standard treatment for heart failure including diuresis and β -receptor blockers. The patients were given sacubatril valsartan at a small dose of 25–50 mg twice a day. According to the patient’s tolerance, the dose was doubled and increased once every 2–4 weeks until the maintenance dose was reached. After 12 months of treatment, the LVEF, LVDd and LVDs of cardiac function in two groups were compared before and after treatment, and the SBP, DBP, blood K+, blood Na+, CTNT, NT-proBNP were observed. Results After treatment, the LVEF of patients in the two groups was increased, while the LVDd and LVDs were decreased. There was statistical difference in LVEF and LVDs between the two groups (P < 0.05), but no statistical difference in LVDd (P > 0.05). After treatment, the levels of blood K+, blood Na+, and CTNT increased in the two groups, there was no significant difference between the two groups after treatment (P > 0.05); NT proBNP decreased significantly after treatment (P < 0.05). After treatment, the systolic blood pressure in the experimental group increased compared with that before treatment, while there was no significant change in the control group (P > 0.05), and there was no significant difference in diastolic blood pressure between the two groups (P > 0.05). Conclusion The treatment of HFrEF combined with hypotension in patients taking sacubatril valsartan can improve heart function, it has no effect on blood pressure, and is safe. [ABSTRACT FROM AUTHOR]