Sacubitril-valsartan versus losartan in heart failure
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Sacubitril-Valsartan vs. Losartan in Heart Failure: Efficacy and Safety
Heart Failure Outcomes: Sacubitril-Valsartan Compared to Losartan
Research shows that sacubitril/valsartan provides greater improvements in heart function compared to losartan in patients with heart failure. In a randomized clinical trial involving patients with right heart failure, sacubitril/valsartan led to significantly better improvements in left ventricular ejection fraction (LVEF), right ventricular function, and symptoms such as dyspnea on exertion, compared to both losartan and captopril. The severity of right ventricular dysfunction and tricuspid regurgitation also decreased more in the sacubitril/valsartan group. Mortality rates were similar across all groups, but more patients in the losartan group reached the optimal dose compared to sacubitril/valsartan, possibly due to tolerability differences .
Safety in Patients with Chronic Kidney Disease and Dialysis
In patients with heart failure undergoing dialysis, sacubitril/valsartan and losartan showed similar safety profiles. Over three months, there were no significant differences in blood pressure or serum potassium levels between the two drugs, and no episodes of hyperkalemia or hypotension were reported in either group. This suggests that sacubitril/valsartan is as safe as losartan for heart failure patients on dialysis .
Broader Evidence: Sacubitril-Valsartan vs. Other Renin-Angiotensin System Inhibitors
Large pooled analyses and systematic reviews confirm that sacubitril/valsartan reduces the risk of cardiovascular death, heart failure hospitalization, and all-cause mortality more effectively than standard renin-angiotensin system inhibitors (such as enalapril or valsartan). These benefits are most pronounced in patients with reduced ejection fraction, but some advantages extend to those with mildly reduced ejection fraction as well 4578910. Sacubitril/valsartan also improves cardiac remodeling and quality of life in these patients .
Real-World Effectiveness and Tolerability
Real-world studies support the findings from clinical trials, showing that sacubitril/valsartan is effective in reducing hospitalizations and mortality in diverse heart failure populations. The most common side effects are hypotension and hyperkalemia, but these are generally manageable . In patients with advanced chronic kidney disease or end-stage renal disease, sacubitril/valsartan is associated with lower long-term mortality and greater improvement in LVEF compared to other angiotensin receptor blockers .
Cost and Adoption
Despite its clinical benefits, the adoption of sacubitril/valsartan has been slow, partly due to higher out-of-pocket costs compared to older medications like losartan. Adherence rates are moderate, with a significant proportion of patients discontinuing the drug within six months .
Conclusion
Sacubitril/valsartan offers superior improvements in heart function and reductions in hospitalizations and mortality compared to losartan and other standard therapies in heart failure, especially for patients with reduced ejection fraction. It is safe for use in patients with chronic kidney disease and those on dialysis, with a tolerability profile similar to losartan. However, higher costs may limit its widespread use. Overall, sacubitril/valsartan is a strong option for heart failure management, particularly when optimal clinical outcomes are the priority 12456789+1 MORE.
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