Prolonged First-Dose Hypotension Induced by Sacubitril/Valsartan

Area of Science:

• Cardiology
• Pharmacology

Background:

• Sacubitril/valsartan (Entresto) is a recommended first-line therapy for heart failure with reduced ejection fraction (HFrEF).
• Angiotensin-converting enzyme inhibitors (ACEIs) are standard HF treatments, but first-dose hypotension is a known limitation.
• Previous reports indicate hypotension from ACEIs typically occurs 3-5 hours after the initial dose.

Observation:

• This case report details a patient experiencing delayed onset (8-18 hours) and prolonged duration (3-6 days) of hypotension after the first dose of Entresto.
• This hypotension pattern differs significantly from previously documented responses to ACEIs.

Findings:

• The observed hypotension associated with Entresto demonstrated a delayed onset and extended duration.
• This contrasts with the typical 3-5 hour onset of hypotension seen with traditional ACE inhibitors.

Implications:

• The unique hypotension pattern associated with Entresto requires further investigation.
• Understanding this phenomenon is crucial for safe and effective Entresto prescribing in heart failure management.
• Clinical guidelines may need to consider this delayed hypotension when initiating Entresto therapy.