Dilated cardiomyopathy has an extremely poor prognosis, sacubitril/valsartan and dapagliflozin are important drugs to improve the prognosis. However, patients with dilated cardiomyopathy tend to have low blood pressure, which would make it unable to use both drugs at the same time. There is no comparative study of the efficacy and safety of sacubitril/valsartan and dapagliflozin in the treatment of dilated cardiomyopathy with low blood pressure.

To investigate the efficacy and safety of sacubitril/valsartan and dapagliflozin in dilated cardiomyopathy patients with low blood pressure.

A total of 124 patients with dilated cardiomyopathy admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to May 2022 were selected as the study subjects. All patients were diagnosed with dilated cardiomyopathy for the first time, and the systolic blood pressure (SBP) was 95-110 mmHg before medication. Patients were prescribed with sacubitril/valsartan (50 mg/time, twice a day) or dapagliflozin tablets (10 mg/time, once a day) before or at discharge and divided into the sacubitril/valsartan group (71 cases) and dapagliflozin group (53 cases) according to clinical drug use. The outpatient follow-up was performed 6 months after discharge until November 2022. General information of the two groups such as age and gender were collected through the hospital electronic medical record system, baseline and 6-month follow-up SBP, diastolic blood pressure (DBP) , and BMI of the two groups were recorded. Baseline and 6-month biochemical indicators〔N-terminal pro-B-type natriuretic peptide (NT-proBNP) , glycated hemoglobin (HbA_1c) , fasting blood glucose (FBG) , estimated glomerular filtration rate (eGFR) , blood potassium〕, cardiac function indicators〔left ventricular ejection fraction (LVEF) , left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic diameter (LVESD) , left atrial diameter (LAD) 〕, 6 min walking test (6MWT) and clinical events were collected. The biochemical indicators, cardiac function indicators and incidence of clinical events before and after treatment were compared between the two groups.

Compared with the pre-treatment period, the levels of blood potassium, LVEF and 6MWT were increased in the sacubitril/valsartan group and dapagliflozin group after 6 months of treatment (P<0.05) , and the elevations of 6MWT level in the dapagliflozin group was higher than that in the sacubitril/valsartan group (t=2.444, P=0.016) . Compared with the pre-treatment period, the levels of SBP, DBP, BMI, NT-proBNP, HbA_1c, FBG, LVEDD, LVESD, LAD were decreased in the sacubitril/valsartan group and dapagliflozin group after 6 months of treatment (P<0.05) , the reductions of SBP (Z=5.217, P<0.001) , DBP (t=3.070, P=0.003) , eGFR (Z=2.495, P=0.013) levels in the sacubitril/valsartan group and BMI (Z=4.410, P<0.001) , HbA_1c (Z=4.493, P<0.001) , FBG (t=4.832, P<0.001) , LAD (Z=2.830, P=0.005) levels in the dapagliflozin group were higher. There were no deaths or hypoglycemic discontinuation events in the two groups during 6 months of follow-up, and there were no statistical differences in the incidence of hypotension discontinuation, hyperkalemia discontinuation, renal insufficiency discontinuation, urinary system infection discontinuation and heart failure re-hospitalization between the two groups (P>0.05) .

Both sacubitril/valsartan and dapagliflozin were effective in improving cardiac function in dilated cardiomyopathy patients with low blood pressure. The safety of the two groups is similar. However, the use of sacubitril/valsartan should be noted for the risk of hypotension and renal insufficiency.