AimsTo evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON‐HF trial.Methods and resultsA total of 4796 participants ≥50 years of age with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were divided into three age groups: <65 years (n = 825), 65–74 years (n = 1772), and ≥75 years (n = 2199). Echocardiograms of 1097 patients were analysed in a standardized fashion at a core imaging laboratory. The primary composite outcome was total HF hospitalizations and cardiovascular (CV) death. Older patients were more likely to experience primary composite outcomes (compared to patients <65 years, adjusted rate ratio [aRR] for ≥75 years: 1.39, 95% confidence interval [CI] 1.21–1.61), total HF hospitalization (aRR 1.27, 95% CI 1.09–1.49), and CV death (adjusted hazard ratio [aHR] 2.04, 95% CI 1.44–2.87). Age did not modify the effect of sacubitril/valsartan compared to valsartan on primary composite endpoint (pinteraction = 0.79) in the overall population or in those with LVEF ≤57%. Older adults randomized to sacubitril/valsartan were more likely to develop hypotension compared to those receiving valsartan (pinteraction = 0.026). Older patients had smaller left ventricular chamber sizes, higher LVEF, and were more likely to have abnormal measures of diastolic function.ConclusionOlder patients with HF with preserved ejection fraction had higher event rates than younger patients, more adverse events overall, and more hypotension when treated with sacubitril/valsartan; however, the treatment benefits of sacubitril/valsartan were retained in older patients.

中文翻译：

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沙库巴曲/缬沙坦对 PARAGON-HF 射血分数保留的心力衰竭的影响


目的在 PARAGON-HF 试验中，评估沙库巴曲/缬沙坦与缬沙坦相比在各年龄组中的临床结果、超声心动图特征以及疗效和安全性。方法和结果共有 4796 名患有慢性心力衰竭 （HF） 且左心室射血分数 （LVEF） ≥45% 的参与者≥被分为三个年龄组：<65 岁 （n = 825）、65-74 岁 （n = 1772） 和 ≥75 岁 （n = 2199）。在核心成像实验室以标准化方式分析 1097 例患者的超声心动图。主要复合结局是 HF 总住院人数和心血管 （CV） 死亡人数。老年患者更有可能经历主要复合结局 （与患者 <65 岁相比，调整后比率 [aRR] ≥75 岁：1.39,95% 置信区间 [CI] 1.21-1.61），总 HF 住院率 （aRR 1.27,95% CI 1.09-1.49） 和 CV 死亡 （调整后风险比 [aHR] 2.04,95% CI 1.44-2.87）。与缬沙坦相比，年龄并未改变沙库巴曲/缬沙坦对总人群或 LVEF ≤57] 患者的主要复合终点 （pinteraction = 0.79） 的影响。与接受缬沙坦治疗的老年人相比，随机分配至沙库巴曲/缬沙坦治疗的老年人更容易发生低血压 （pinteraction = 0.026）。老年患者的左心室腔体积较小，LVEF 较高，并且更可能出现舒张功能异常。结论射血分数保留的老年 HF 患者在接受沙库巴曲/缬沙坦治疗时事件发生率高于年轻患者，总体不良事件更多，低血压更多;然而，沙库巴曲/缬沙坦的治疗益处在老年患者中得以保留。