The management of asymptomatic hypotension in patients on sacubitril/valsartan remains debated. A multicenter retrospective study, published in the Journal of Cardiology, assessed outcomes in 992 patients with chronic heart failure initiated on sacubitril/valsartan. The study examined whether the presence of hypotension, either symptomatic or asymptomatic, influenced prognosis and treatment decisions.

Within three months, 7.3% of patients developed symptomatic hypotension and 12.3% experienced asymptomatic hypotension. Cardiovascular events, defined as cardiovascular death or hospitalization for heart failure, were more frequent in patients with hypotension compared to those without (Log-rank p < 0.05). Importantly, no prognostic difference was seen between symptomatic and asymptomatic groups. However, among patients with asymptomatic hypotension, those who discontinued sacubitril/valsartan within three days had significantly higher event rates than those who continued therapy (Log-rank p = 0.01).

The findings suggest that continuation of sacubitril/valsartan, even in the presence of asymptomatic hypotension, may provide prognostic benefit and avoid excess cardiovascular risk.