{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:04:01Z","timestamp":1760123041237,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T00:00:00Z","timestamp":1607126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Widespread use of angiotensin receptor blocker and neprilysin inhibitor (ARNI) remains low, and many patients are unable to tolerate the medication due to hypotension at the currently recommended starting dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>The aim of this study is to assess if lower than standard doses of ARNI, sacubitril\/valsartan (S\/V), significantly reduces NT\u2010proBNP and leads to any change in diuretic dose, serum potassium, or creatinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective study of 278 patients who were started on a low dose S\/V at a single medical center, 45 patients were selected for the study cohort. Patients were subcategorized to Group 1 (<jats:italic>n<\/jats:italic> = 10): very low dose S\/V (half a tab of 24\/26\u2009mg BID), Group 2 (<jats:italic>n<\/jats:italic> = 10): very low dose titrated to low dose S\/V, and Group 3 (<jats:italic>n<\/jats:italic> = 25): low dose S\/V (24\/26\u2009mg BID). NT\u2010proBNP, diuretic dose, serum potassium, and creatinine were compared before and after initiation of S\/V.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among all groups, there was a significant reduction in NT\u2010proBNP level (Group 1: p\u2009&lt;\u2009.01, Group 2: p\u2009&lt;\u2009.01, and Group 3: p\u2009&lt;\u2009.001). In addition, there was a significant reduction in diuretic dose across all groups combined (furosemide 53\u2009mg\/day vs. 73\u2009mg\/day; p = .03), with 17.8% (8\/45) patients being able to discontinue their diuretic completely. There was no significant change in potassium or creatinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Lower than standard dose of S\/V significantly reduces NT\u2010proBNP and diuretic requirement without change in potassium or creatinine, which provides hope that patients who cannot tolerate standard doses of S\/V due to hypotension may be able to receive the benefits of S\/V therapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23509","type":"journal-article","created":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T11:49:37Z","timestamp":1607168977000},"page":"85-90","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Novel doses of sacubitril\/valsartan in patients unable to tolerate traditional therapy: Effects on <scp>N\u2010terminal<\/scp> pro <scp>B\u2010type<\/scp> natriuretic peptide levels"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1541-7023","authenticated-orcid":false,"given":"Amitabh C.","family":"Pandey","sequence":"first","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"},{"name":"Scripps Research Translational Institute The Scripps Research Institute  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Jer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth S.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H.","family":"Yoo","sequence":"additional","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Christophy","sequence":"additional","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"},{"name":"Section of Advanced Heart Failure and Mechanical Circulatory Support, Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev C.","family":"Mohan","sequence":"additional","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"},{"name":"Section of Advanced Heart Failure and Mechanical Circulatory Support, Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay V.","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"},{"name":"Section of Advanced Heart Failure and Mechanical Circulatory Support, Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Thomas","family":"Heywood","sequence":"additional","affiliation":[{"name":"Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California USA"},{"name":"Section of Advanced Heart Failure and Mechanical Circulatory Support, Division of Cardiology Scripps Prebys Cardiovascular Institute, Scripps Clinic  La Jolla California 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predictors, and outcomes associated with hypotensive episodes among heart failure patients receiving sacubitril\/valsartan or enalapril: the PARADIGM\u2010HF trial (prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin\u2010converting enzyme inhibitor to determine impact on global mortality and morbidity in heart failure)","volume":"11","author":"Vardeny O","year":"2018","journal-title":"Circ Heart 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