{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:15:44Z","timestamp":1792127744107,"version":"4.4.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Achieving target doses of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) is often challenging due to concerns related to hypotension. This study evaluated dose-dependent effects of ARNI considering on-treatment blood pressure (BP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From a multicenter HF registry, 1,097 HFrEF patients receiving ARNI for \u22656 months were stratified into low-dose (&lt;100 mg\/day, n\u2009=\u2009249) and intermediate-to-high-dose (\u2265100 mg\/day, n\u2009=\u2009848) groups. Echocardiographic changes and clinical outcomes were compared across groups, considering on-treatment BP profiles (high-BP\u2009\u2265\u2009110 mmHg vs. low-BP\u2009&lt;\u2009110 mmHg).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Low on-treatment BP was independently associated with low-dose ARNI use. Both dose groups showed echocardiographic improvement, but the intermediate-to-high-dose group had more pronounced changes. Over 3.1 years (median follow-up), low-dose ARNI use was associated with a higher risk of mortality compared to intermediate-to-high-dose. These trends were consistently observed in both high-BP and low-BP profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low-dose ARNI use was associated with less improvement in myocardial function and worse clinical outcomes, even in patients with low-BP profiles. This highlights the importance of optimal ARNI dose titration despite low BP concerns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0328971","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T17:38:17Z","timestamp":1753724297000},"page":"e0328971","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["On-treatment blood pressure and dose-dependent effects of ARNI in heart failure with reduced ejection fraction: Insights from a multicenter registry"],"prefix":"10.1371","volume":"20","author":[{"given":"Jiesuck","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Soon","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Min","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3157-0247","authenticated-orcid":true,"given":"Hye 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