Info

🌱 來自：Treatment of Chronic HF with Reduced EF

RASi ACEI ARB

Choose one of ARNI (ARB + neprilysin inhib), ACEI or ARB

36-hr washout when transitioning ACEI to ARNI

• ARNI preferred RASi in NYHA II-IV.
  • Neutral endopeptidase (NEP, aka neprilysin) degrades natriuretic peptides,
    • bradykinin & angiotensins.
  • Valsartan + sacubitril (NEPi) ↓ CV mort & HF hosp c/w ACEi;
    • ↑ HoTN, AKI (NEJM 2014;371:993 & 2019;380:539).
  • Contraindicated if h/o angioedema.
  • BNP 應該會上升 ↑ ，因 為: ARNI 含有 neprilysin inhibitor，
    • 會減少 BNP 的 → 降解，
    • 使用 ARNI 的 → 期間，可以 ✔ 用 NT pro-BNP 來監測 HF
• ACEI: if unable to tolerate or afford ARNI. ↓ mortality vs. placebo.
  • High-dose more effic. than low.
• Watch for
  • ↑ Cr,
  • ↑ K (ameliorate by low-K diet, diuretics, K binders),
  • cough,
  • angioedema.
• ARB:
  • consider if cannot tolerate
  • ACEI (eg, b/c cough) as noninferior