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Angiotensin-Neprilysin Inhibition and Renal Outcomes in Heart Failure With Preserved Ejection Fraction
- Source :
- Circulation, 142(13), 1236-1245. LIPPINCOTT WILLIAMS & WILKINS
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- Background: In patients with heart failure, chronic kidney disease is common and associated with a higher risk of renal events than in patients without chronic kidney disease. We assessed the renal effects of angiotensin/neprilysin inhibition in patients who have heart failure with preserved ejection fraction enrolled in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction). Methods: In this randomized, double-blind, event-driven trial, we assigned 4822 patients who had heart failure with preserved ejection fraction to receive sacubitril/valsartan (n=2419) or valsartan (n=2403). Herein, we present the results of the prespecified renal composite outcome (time to first occurrence of either: ≥50% reduction in estimated glomerular filtration rate (eGFR), end-stage renal disease, or death from renal causes), the individual components of this composite, and the influence of therapy on eGFR slope. Results: At randomization, eGFR was 63±19 mL·min –1 ·1.73 m – 2. At study closure, the composite renal outcome occurred in 33 patients (1.4%) assigned to sacubitril/valsartan and 64 patients (2.7%) assigned to valsartan (hazard ratio, 0.50 [95% CI, 0.33–0.77]; P =0.001). The treatment effect on the composite renal end point did not differ according to the baseline eGFR (–1 ·1.73 m –2 ( P -interaction=0.92). The decline in eGFR was less for sacubitril/valsartan than for valsartan (–2.0 [95% CI, –2.2 to –1.9] versus –2.7 [95% CI, –2.8 to –2.5] mL·min –1 ·1.73 m –2 per year). Conclusions: In patients with heart failure with preserved ejection fraction, sacubitril/valsartan reduced the risk of renal events, and slowed decline in eGFR, in comparison with valsartan. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920711.
- Subjects :
- CHRONIC KIDNEY-DISEASE
medicine.medical_specialty
Angiotensins
NEPHROPATHY
heart failure
Kidney
CANDESARTAN
renal insufficiency
Nephropathy
MORBIDITY
LEFT-VENTRICULAR DYSFUNCTION
Irbesartan
Double-Blind Method
Physiology (medical)
Internal medicine
medicine
Humans
LCZ696
Myocardial infarction
Enalapril
Renal Insufficiency, Chronic
Aged
Aged, 80 and over
IRBESARTAN
business.industry
Aminobutyrates
Biphenyl Compounds
Stroke Volume
Middle Aged
medicine.disease
chronic
Candesartan
MYOCARDIAL-INFARCTION
Heart failure
ENALAPRIL
treatment outcome
SURVIVAL
Cardiology
Valsartan
Neprilysin
Cardiology and Cardiovascular Medicine
business
Heart failure with preserved ejection fraction
Glomerular Filtration Rate
Kidney disease
medicine.drug
Subjects
Details
- ISSN :
- 15244539 and 00097322
- Volume :
- 142
- Database :
- OpenAIRE
- Journal :
- Circulation
- Accession number :
- edsair.doi.dedup.....375de5862b1476746a17a7b31d35c79f