What you need to know when using sacubitril/valsartan to treat heart failure

Huazi met a patient with heart failure, a man in his 50s. He told Huazi that the doctor asked him to take sacubitril-valsartan, but the price of this medicine was not cheap. Was it really necessary to take it? Was there any other medicine that could replace it?

Huazi told him that sacubitril-valsartan is the world's first angiotensin receptor neprilysin inhibitor (ARNI) to be marketed. It is a first-line drug for the treatment of chronic heart failure and can also be used to treat hypertension. Currently, there is no other drug that can replace it. As long as economic conditions allow, it should be kept in the drug treatment plan.

1. Heart failure is the final stage of all heart diseases Huazi told the patient to understand the seriousness of heart failure. This is a progressive disease, which is caused by various heart diseases leading to decreased heart function, the main cause of which is high blood pressure. When heart function decreases, blood return and cardiac ejection will be affected, and various organs in the body will have dysfunction due to insufficient blood supply.

Heart failure is the terminal stage of all heart diseases, and its mortality rate is similar to that of malignant tumors, with a 5-year mortality rate of 50%. Therefore, once heart failure occurs, it must not be taken lightly, and active treatment is needed to control disease progression, prolong survival, and improve quality of life.

2. The "Golden Triangle" in the Treatment of Heart Failure There is a "Golden Triangle" combination of drugs for the treatment of heart failure, which refers to the combined treatment of three types of drugs.

The first type of drugs is pril drugs and sartans drugs, which inhibit the renin-angiotensin-aldosterone system (RAAS), delay ventricular remodeling, and prevent ventricular enlargement. They are the cornerstone of treating heart failure.

The second type of drugs is Lolamine drugs, which inhibit cardiac excitability, reduce the stimulation of catecholamine hormones on the heart, and reduce the incidence of sudden death.

The third type of drug is aldosterone receptor antagonists, which counteract the water and sodium retention caused by aldosterone. When used in combination with other drugs, they can delay disease progression and reduce the risk of death.

3. Sacubitril and valsartan can be a new member of the "Golden Triangle". The human heart and vascular endothelial cells can secrete natriuretic peptides, which can produce sodium excretion and diuresis, inhibit aldosterone secretion, inhibit RAAS, and inhibit myocardial fibrosis. However, naturally secreted natriuretic peptides will soon be degraded by enzymes, and the duration of action is very short. Sacubitril is an enkephalinase inhibitor, which can inhibit the degradation of natriuretic peptides, increase their concentration, and enhance their effects.

In the original "Golden Triangle", pril drugs are often used to inhibit RAAS, but they are prone to side effects such as dry cough. If they cannot be tolerated, sartan drugs need to be used instead.

Sacubitril/valsartan is a single cocrystal drug with good stability, high bioavailability, and low adverse reactions. It can inhibit RAAS while increasing the level of natriuretic peptides. It can replace pril drugs as a new member of the "Golden Triangle".

4. What should be noted when using sacubitril valsartan? Prils inhibit the degradation of bradykinin, which may cause dry cough and angioedema, and sacubitril valsartan can also inhibit the degradation of bradykinin, so the two cannot be used together, otherwise it will increase the potential risk. People taking prils need to stop taking them for 36 hours before changing the medicine.

The medicine already contains valsartan, so do not take it with other sartan medicines.

Sacubitril/valsartan has a blood pressure lowering effect and is suitable for patients with heart failure and hypertension, but patients with low blood pressure (systolic pressure below 100 mmHg) should use it with caution. Hyperkalemia may occur during medication, and blood potassium needs to be monitored.

Sacubitril/valsartan will inhibit RAAS and may cause renal damage. Renal function needs to be monitored during medication.

In summary, sacubitril-valsartan is a first-line drug for the treatment of heart failure. It treats heart failure by increasing natriuretic peptide levels and inhibiting RAAS. It can also be used to treat hypertension. Compared with pril drugs and sartan drugs that simply inhibit RAAS, sacubitril-valsartan is more effective in treating heart failure and has fewer adverse reactions. However, its high price limits its widespread application.

Medicines should be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.