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Small tolerated enalapril doses before ARNI administration predicts adverse events during ARNI up-titration

Session Poster Session 2

Speaker Argyrios Ntalianis

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Pharmacotherapy
  • Session type : Poster Session

Authors : A Ntalianis (Athens,GR), IP Petropoulous (Athens,GR), I Stamoulopoulos (Athens,GR), E Repasos (Athens,GR), G Maglaras (Athens,GR), A Mareti (Athens,GR), M Kondylis (Athens,GR), N Zografos (Athens,GR), A Koen (Athens,GR), K Tampakis (Athens,GR), A Misegiannidis (Athens,GR), E Venieri (Athens,GR), N Makris (Athens,GR), I Kanakakis (Athens,GR), I Paraskevaidis (Athens,GR)

A Ntalianis1 , IP Petropoulous1 , I Stamoulopoulos1 , E Repasos1 , G Maglaras1 , A Mareti1 , M Kondylis1 , N Zografos1 , A Koen1 , K Tampakis1 , A Misegiannidis1 , E Venieri1 , N Makris1 , I Kanakakis1 , I Paraskevaidis1 , 1University of Athens Medical School, Dept of Clinical Therapeutics, Alexandra Hospital - Athens - Greece ,

Chronic Heart Failure: Pharmacotherapy

Background/Introduction: The maximum recommended dose (200 mg BID) of sabutipril-valsartan (ARNI) is associated with better prognosis in patients with heart failure and reduced ejection fraction (HFrEF). Theoretically, small tolerated enalapril doses might associate with lower ARNI tolerated doses

Purpose: To investigate the possible association of small tolerated enalapril doses before ARNI with adverse events after ARNI switch.

Methods: Patients with HFrEF (EF£35%), NYHA class II and III at maximum tolerated dose of ß-blocker, enalapril and spironolactone were considered eligible for the study. All patients were switched from enalapril to ARNI which it was progressively up-titrated every week from 50mg BID to 100mg BID and eventually 200mgX2. Enalapril dosage £5 mg BID prior to ARNI was considered as  "low dose" (LD), while a dose> 5 mg / BID was considered as a "high dose" (HD).

Results: A total of 33 patients with a mean age of 59.5 years (84.8% with ischemic myocardiopathy) were prospectively included. 82% of patients were receiving LD of enalapril before ARNI and 18% HD. Overall, 70% of the patients were titrated to the maximum dose of ARNI. Fewer LD patients were up-titrated to the maximum target ARNI dose as compared with the HD group patients (66.6% vs. 83.3%, p=0.01). Only patients in the LD group experienced adverse events during ARNI up-titration (1 patient asymptomatic hypotension, 2 patients symptomatic hypotension and 2 patients hyperkalaemia).

Conclusions: Low tolerated enalapril doses before ARNI administration are associated with a lower probability of ARNI up-titration at the maximum recommend dose and more adverse effects during ARNI administration.

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