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Abstract
While conferring morbidity and mortality benefit, potential exists for significant day time or night time hypotension culminating in organ hypoperfusion. The advent of sacubitril/valsartan(S/V) may potentiate the risk, impacting on diurnal BP pattern which has not to our knowledge been assessed. We previously analysed 24 hour AMBP pattern in this population on maximum tolerated disease modifying therapies. A debate is generated as to whether the benefits of vasoactive therapy may be mitigated by pronounced hypoperfusion compromising coronary or cerebral blood flow.
Methods From the AMBP readings at the Heartbeat Trust, this ongoing study is assessing the difference between the clinic systolic BP and mean daytime systolic BP, and the fraction of the monitored time spent below the critical cut off readings of 100, 90 mmHg systolic and 70, 60 mmHg diastolic.
Results To date, 22 patients (average age 71) have been analysed with a predominant ischaemic aetiology (68%). The mean clinic SBP is 22 mmHg and 24 mmHg higher than mean daytime SBP and average 24 hour SBP respectively. 75% patients were on maximal tolerated S/V in addition to standard therapy with the remaining on maximal tolerated ACEi, B blocker and mineralocorticoid receptor antagonist. The percentage time spent below vital blood pressure thresholds was as follows; SBP <100 =24%, DBP <70 =63%, SBP <90 =6%, DBP <60 =32%. This ongoing study shows two initially interesting observations. Firstly, a sizeable proportion of this population spend a significant time duration under key BP cut offs. Also, there is a substantial difference between the clinic SBP and daytime SBP, potentially underscoring the need to be careful when increasing therapy strength in borderline acceptable readings. Further work is needed to determine if documented hypotension has meaningful clinically impact.