Heart failure & cardiomyopathies
Sacubitril/Valsartan Versus Valsartan Initiation in Patients Naïve to Renin–angiotensin System Inhibitors: Insights from PARAGLIDE-HF
Authors' conclusion
In HF with EF >40% stabilized after worsening HF, safety and efficacy were similar irrespective of ACEi/ARB status at baseline
Study context
- Population
- Patients with heart failure (HF) and ejection fraction (EF) >40% stabilized after worsening HF107 (23%) angiotensin-converting enzyme inhibitors (ACEi)/ARB naïve
- Participants
- 466 patients
- Comparison
- Sac/Val vs valsartan, by baseline ACEi/ARB status
- Primary endpoint
- Time-averaged proportional change in NT-proBNP from baseline
- Follow-up
- Weeks 4 and 8
Methodological detailspre-specified analysis, double-blind, subgroups by baseline ACEi/ARB status
- Pre-specified analysis
- Double-blind
- Subgroups by baseline ACEi/ARB status
Primary result
As reported in the abstract
NT-proBNP, by ACEi/ARB status (subgroups)
- ACEi/ARB naïve
- 0.76 (95% CI 0.51–1.13)
- ACEi/ARB users
- 0.88 (95% CI 0.74–1.05)
Further findings
Win ratio, hierarchical outcome (CV death, HF hospitalisations, urgent HF visits, NT-proBNP change), by baseline ACEi/ARB status
- Win ratio, ACEi/ARB users
- 1.13 (95% CI 0.86-1.49)
- Win ratio, ACEi/ARB naïve
- 1.38 (95% CI 0.81-2.37)
- Pinteraction = 0.51
Safety
Symptomatic hypotension and worsening renal function, ACEi/ARB naïve
- Symptomatic hypotension, ACEi/ARB naïve, OR
- 1.79 (95% CI 0.68-4.72)
- Worsening renal function, ACEi/ARB naïve, OR
- 0.71 (95% CI 0.29-1.78)
- Non-significant interactions by ACEi/ARB status
Original publication
Sacubitril/Valsartan Versus Valsartan Initiation in Patients Naïve to Renin–angiotensin System Inhibitors: Insights from PARAGLIDE-HF. Eur J Heart Fail. Published 10 January 2025. doi:10.
Summarised from the published abstract; every number is checked against it