{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:20:33Z","timestamp":1781104833090,"version":"3.54.1"},"reference-count":21,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,10,6]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with heart failure exhibiting low systolic blood pressure (SBP) have a poor prognosis. Sacubitril\/valsartan reduces cardiovascular events; however, its use in patients with low SBP has not been fully examined. Therefore, in this study, we aimed to investigate the association between baseline SBP and adverse events (AEs) in patients starting sacubitril\/valsartan therapy using data from a real-world registry in Japan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed data from a multicentre retrospective study, including patients who initiated sacubitril\/valsartan between August 2020 and August 2021. The patients were categorised into five groups based on their baseline SBP (&lt;100, 100\u2013109, 110\u2013119, 120\u2013129 and \u2265130\u2009mm\u2009Hg). The composite of AEs occurring within 3 months according to baseline SBP and the patient characteristics associated with AEs in a baseline SBP &lt;110\u2009mm\u2009Hg were analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among the 964 patients newly prescribed sacubitril\/valsartan, the median (IQR) age was 73 (61\u201380) years, and 388 (40.2%) patients had a baseline SBP &lt;110\u2009mm\u2009Hg. AEs occurred in 24% (n=232) of patients. The adjusted ORs for all AEs were 1.91 (95% CI (CI) 1.13\u20133.23; p=0.02) for the SBP &lt;100\u2009mm\u2009Hg group and 3.33 (95% CI 1.98 to 5.59; p&lt;0.001) for the SBP 100\u2013109\u2009mm\u2009Hg group, compared with the SBP 110\u2013119\u2009mm\u2009Hg group. In patients with a baseline SBP &lt;110\u2009mm\u2009Hg, factors associated with an increased risk of AEs included a higher New York Heart Association class (II, III or IV) and a lower estimated glomerular filtration rate &lt;30\u2009mL\/min\/1.73 m<jats:sup>2<\/jats:sup>.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Caution is needed when initiating sacubitril\/valsartan in patients with lower baseline SBP. The severity of heart failure and kidney function may be useful for risk stratification in these high-risk patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-002764","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T14:10:23Z","timestamp":1729519823000},"page":"e002764","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Risk stratification by renal function and NYHA class in patients with hypotension initiated on sacubitril\/valsartan: a retrospective cohort study from 17 centres in Japan"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-7835","authenticated-orcid":false,"given":"Koshiro","family":"Kanaoka","sequence":"first","affiliation":[{"name":"Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"},{"name":"Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahito","family":"Nasu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Osaka General Medical Center, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Ijichi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiro","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Kida","sequence":"additional","affiliation":[{"name":"Cardiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Kagiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan"},{"name":"Department of Digital Health and Telemedicine R&D, Juntendo University, Bunkyo-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan"},{"name":"Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syunsuke","family":"Ishii","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, none, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Iwanaga","sequence":"additional","affiliation":[{"name":"Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-1954","authenticated-orcid":false,"given":"Shingo","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Toho University Graduate School of Medicine, Ota-ku, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"2025081710162471000_11.2.e002764.1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-012-9315-1"},{"key":"2025081710162471000_11.2.e002764.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.11.004"},{"key":"2025081710162471000_11.2.e002764.3","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.114"},{"key":"2025081710162471000_11.2.e002764.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2025081710162471000_11.2.e002764.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"2025081710162471000_11.2.e002764.6","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1161\/CIRCULATIONAHA.119.044586","article-title":"Sacubitril\/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure","volume":"141","author":"Solomon","year":"2020","journal-title":"Circulation"},{"key":"2025081710162471000_11.2.e002764.7","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1908655"},{"key":"2025081710162471000_11.2.e002764.8","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1093\/eurheartj\/ehw570","article-title":"Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril\/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF","volume":"38","author":"B\u00f6hm","year":"2017","journal-title":"Eur Heart J"},{"key":"2025081710162471000_11.2.e002764.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.02.009"},{"key":"2025081710162471000_11.2.e002764.10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jjcc.2023.11.005","article-title":"Relevant adverse events and drug discontinuation of sacubitril\/valsartan in a real-world Japanese cohort: REVIEW-HF registry","volume":"84","author":"Matsumoto","year":"2024","journal-title":"J Cardiol"},{"key":"2025081710162471000_11.2.e002764.11","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.jchf.2022.07.001","article-title":"Age Differences in Effects of Sacubitril\/Valsartan on Cardiac Remodeling, Biomarkers, and Health Status","volume":"10","author":"Murphy","year":"2022","journal-title":"JACC Heart Fail"},{"key":"2025081710162471000_11.2.e002764.12","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1498"},{"key":"2025081710162471000_11.2.e002764.13","first-page":"336","article-title":"Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction","volume":"10","author":"Cikes","year":"2022","journal-title":"JACC HF"},{"key":"2025081710162471000_11.2.e002764.14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1536867X1101100101","article-title":"A Procedure to Tabulate and Plot Results after Flexible Modeling of a Quantitative Covariate","volume":"11","author":"Orsini","year":"2011","journal-title":"The Stata Journal: Promoting communications on statistics and Stata"},{"key":"2025081710162471000_11.2.e002764.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61913-9"},{"key":"2025081710162471000_11.2.e002764.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.107.736975"},{"key":"2025081710162471000_11.2.e002764.17","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1002\/ejhf.548","article-title":"Initiating sacubitril\/valsartan (LCZ696) in heart failure: results of TITRATION, a double\u2010blind, randomized comparison of two uptitration regimens","volume":"18","author":"Senni","year":"2016","journal-title":"European J of Heart Fail"},{"key":"2025081710162471000_11.2.e002764.18","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1002\/ejhf.580","article-title":"Efficacy of sacubitril\/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM\u2010HF trial","volume":"18","author":"Vardeny","year":"2016","journal-title":"European J of Heart Fail"},{"key":"2025081710162471000_11.2.e002764.19","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/j.jchf.2021.06.018","article-title":"Sacubitril\/valsartan adherence and postdischarge outcomes among patients hospitalized for heart failure with reduced ejection fraction","volume":"9","author":"Carnicelli","year":"2021","journal-title":"JACC Heart Fail"},{"key":"2025081710162471000_11.2.e002764.20","article-title":"Efficacy and Safety of Sacubitril\/Valsartan in High-Risk Patients in the PIONEER-HF Trial","volume":"14","author":"Berg","year":"2021","journal-title":"Circ: Heart Failure"},{"key":"2025081710162471000_11.2.e002764.21","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.007829","article-title":"Racial and Ethnic Differences in Biomarkers, Health Status, and Cardiac Remodeling in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril\/Valsartan","volume":"13","author":"Ibrahim","year":"2020","journal-title":"Circ Heart Fail"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2024-002764","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:16:34Z","timestamp":1755450994000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2024-002764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,10,21]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1136\/openhrt-2024-002764"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2024-002764","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}