中国临床药学杂志

目的 探讨沙库巴曲缬沙坦钠对射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）合并高血压患者的辅助治疗效果影响。方法 纳入2019年1月至2021年12月收治的120例心衰合并高血压患者作为研究对象，其中60例HFrEF合并高血压患者作为HFrEF组，60例HFpEF合并高血压患者作为HFpEF组，2组均接受沙库巴曲缬沙坦钠辅助治疗。比较2组患者的临床疗效、治疗前后血压控制水平、心功能指标[左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）]、肾功能指标[血清纤维蛋白原（FIB），肾小球滤过率（GFR）]炎性因子水平[丝氨酸蛋白酶活性域的NLR家族蛋白3信使核糖核酸（NLRP3mRNA）、血清白细胞介素-1β(IL-1β)]、6min步行试验（6MWT）和N末端前体B型钠尿肽（NT-proBNP），统计不良反应发生率。结果 2组总有效率差异无统计学意义（P> 0.05）。治疗后，HFrEF组的血压明显低于HFpEF组（P <0.05）。2组治疗后的LVESD、LVEDD、FIB较治疗前均显著降低（P <0.05）,GFR显著升高（P <0.05），且治疗后HFrEF组的LVESD、LVEDD、FIB均低于HFpEF组（P<0.05）,GFR高于HFpEF组（P<0.05）。治疗后2组患者的NLRP3mRNA和IL-1β较治疗前均明显降低，且治疗后HFrEF组NLRP3 mRNA和IL-1β低于HFpEF组（P <0.05）。治疗后，2组6MWT距离较治疗前明显提高，NT-proBNP较治疗前明显降低（P<0.05），且治疗后HFrEF组6MWT距离高于HFpEF组（P<0.05）,NT-proBNP低于HFpEF组（P <0.05）。2组不良反应发生率差异无统计学意义（P> 0.05）。结论 沙库巴曲缬沙坦钠对HFpEF和HFrEF合并高血压患者均有较好的辅助治疗效果，可有效调节患者的血压水平，改善心、肾功能，对HFrEF合并高血压患者的治疗效果更佳。

AIM To investigate the adjunctive therapeutic effect of sacubitril valsartan sodium on heart failure with preserved ejection fraction(HFpEF) and heart failure with reduced ejection fraction(HFrEF) combined with hypertension.METHODS From January 2019 to December 2021, a total of 120 patients with heart failure and hypertension were enrolled. Among them, 60 patients with HFrEF combined with hypertension were assigned to the HFrEF group, and 60patients with HFpEF combined with hypertension were assigned to the HFpEF group. Both groups received adjunctive therapy with sacubitril valsartan sodium. The study compared the clinical efficacy, blood pressure control levels before and after treatment, cardiac functional indices [left ventricular end-diastolic diameter(LVEDD) and left ventricular endsystolic diameter(LVESD)], renal function indices [serum fibrinogen(FIB) and glomerular filtration rate(GFR)],inflammatory factor levels [NLR family pyrin domain containing 3 messenger RNA(NLRP3 mRNA) and serum Interleukin-1 beta(IL-1β)], results of the 6-minute walk test(6MWT), and N-terminal pro-brain natriuretic peptide(NTproBNP) between 2 groups. Additionally, the incidence of adverse reactions was analyzed. RESULTS There was no significant difference in the total efficacy rate between 2 groups(P>0.05). After treatment, the blood pressure control level in the HFrEF group was significantly better than that in the HFpEF group(P<0.05). After treatment, both groups showed significant reductions in LVESD, LVEDD, and FIB compared to before treatment(P<0.05), along with a significant increase in GFR(P<0.05). Additionally, post-treatment LVESD, LVEDD, and FIB levels were lower in the HFrEF group than in the HFpEF group(P<0.05), and GFR was higher in the HFrEF group compared to the HFpEF group(P<0.05).After treatment, both groups of patients exhibited significant reductions in NLRP3 mRNA and IL-1β compared to pretreatment levels(P<0.05). Furthermore, post-treatment, there were notable improvements in 6MWT scores and significant reductions in NT-proBNP compared to pre-treatment in both groups(P<0.05). Moreover, after treatment, the HFrEF group demonstrated higher 6MWT scores and lower NT-proBNP levels than the HFpEF group(P<0.05). The incidence of adverse reactions did not significantly differ between 2 groups(P>0.05). CONCLUSION Sacubitril valsartan sodium exhibits a good adjunctive therapeutic effect in patients with HFrEF and HFpEF combined with hypertension. It effectively regulates blood pressure levels and improves cardiac and renal functions. Its therapeutic efficacy appears to be superior in HFrEF patients combined with hypertension.