Hi all - My Dad (88) has recently been diagnosed with Heart Failure (HF) with an Ejection Fraction of 15-20% (so reasonably severe). He also generally has low BP (c.95-105/50-55). He's coped with the first-diagnosed diuretics (Furosemide (now stopped), Spironolactone and Dapagflozin) , but is now struggling to start ENTRESTO.
Prescribed the min/Renal dose (24/26 mg) , but 2 trials now and on both occasions BP has dropped significantly after just one dose (to c.80/c.40-50). and he's not managed the Day 1 second dosage yet. On the second trial, after 24 hrs, he suffered a full-on/keel-over 'faint/black-out'. he is also on Bisoprolol.
Takes the Bisop, Dapag and Spiro all in the morning - and they seem to be dropping an ave. starting BP of 105 lower before the ENTRESTO is added.
Anyone had experience of similar issues ? Ideas on how to manage it - Reschedule other meds ?
Any ideas appreciated. Thanks
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Rog4Dad
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I started on a low dose, and it was stepped up to the max (97/103) after a few months. About a year later I had a very delayed (due to the plague) echoscan which showed the 60% EF, so I don't know the timescale for the improvement.
Sounds like he’s been put straight on Entresto too early. Ramipril is similar to Entresto, they are both excellent heart failure drugs. Entresto is supposed to be better for HF, but it has a greater impact on blood pressure compared to Ramipril! His GP could try him on Ramipril once a day, increasing to twice a day once his BP adjusts and then moving to Entresto. This is the approach the cardiac nurses are taking with my husband, he has very low BP so they didn’t want to start him on Entresto straight away as they knew he wouldn’t be able to tolerate it.
Thanks Clare. HF team mentioned Ramapril when they were pushed on the question "...what if he really cannot tolerate Entresto what then ?" . But seem somewhat reluctant to divert from trialling Entresto.
There may be a reason they’re reluctant to switch to Ramipril, no harm in asking why that is and mentioning you have heard of other patients starting on Ramipril then building up to Entresto. It takes a while to get all the drugs right!
Yes I was put on rampril when in hospital because my blood pressure was to low and couldn’t cope with the entresto. Nearly 6 months on from HA I’m on the highest dosage entresto and they are happy with my blood pressure other day it was 103/55 which they are pleased with.
Hi, I am 73 with a long history of heart problems dating back to 2000 when I had a HA in Greece then a triple on return to UK. Fully recovered and then CA in 2012 with a defib fitted in Toulon. OK until very mild stroke in 2020. Now on entresto 97x2 and find it brilliant having reversed a failing heart scenario. BP typically 100/50 but in morning can dip much lower. Since going on stronger Entresto I am now walking 6k in an hour v previously struggling at 1k! In my opinion it is brilliant but undoubtedly it does lower BP. Worth persevering with as it does seem to dramatically improve heart ejection factor function.
Hi Jak. Great info thank you. Glad you are doing so well after such a bumpy ride with your heart. Is your morning 'dip in BP' resulting from taking the Entresto - and how low does it go ? We were told to expect a poss 15 points drop in the systolic (bigger number) - but actually saw 25 to 30 points drop-down in to the 70's , and Diastolic in to the 40's - and that was somewhat ? All of those numbers after just one dose on the first morning of trialling it . Thanks
Sorry for the delay but been busy on a totally different front. My BP does periodically drop to mid 80's in morning when I am cautious about my activities. I am on half an Inspra too so low BP is my norm. I have tried stopping Inspra and BP is more typically 100/60. As others have advised best to discuss matter with cardiologist. I suspect I am far removed from being the norm.
Awesome. How long were you on it before getting to this level of energy? Is your stamina holding up? I’m 75 and briskly walk 3 miles a day. I’m grateful.
Hi Jak 8. I’m 76 and have a history of heart issues since 2007. I too am walking 5ks and on the middle dose of Entresto. Hopefully I can tolerate the higher dose. Is the Entresto still effective? Cheers.
Entresto can lower BP, but so can bisoprolol and prob some of the others. I built up my entresto level for some months without beta blocker, before adding in bisoprolol in tiny doses, and my normal bp is now about 95-100/55 (just stand up slowly, they say!) Might be advisable to have a cardiologist rethink the whole package of meds and decide what is needed most?
Hi Np - Thanks for the reply. Have asked the HF team to look at the overall meds regime as you have (also) suggested, and agree - a salient point he could be '..what is needed most'. And thank you for the numbers. It is helpful to know what others can cope with. And as for 'standing-up slowly' it's good advice, which Dad already does (involuntarily !) - You'd think after 88 years of practice he'd be quicker at it by now 😉 - perhaps age does bring some benefits after all.
Hey.I have that dose of entresto my BP is too low to go on any of the higher doses. My EF is 10-15%. I also take warfarin, furosemide, dapaglaflozin, bisoprolol and ivabradine. I was on spironolactone but had to have it stopped as it completely drained me, my body is not agree with it. Maybe ask if that can be stopped and see if it helps. I still have days where I'm super tired but can still manage. Hope this helps a little x
Hi Cherrelle - Thanks for sharing your experiences. Dad seems to be coping OK with the Spiro. His initial Furosemide prescription was stopped a few weeks ago (after 2 months) as it had done is job of bulk-shifting fluid that had built-up. We've asked the HF Team to initially look at the timings of his other meds (to avoid all that drop BP being taken at a similar time), but the advice further up the chain of reviewing the criticality of all the meds is another next step I think. Thank you - and I sincerely hope you have more good days than the tired-ones.
My heart failure nurse at hospital would have liked me to take Entresto but said my blood pressure must me over 100 to do so. I have very low blood pressure - oftenin 60's and 70's - as long as I feel well she is not concerned. She said if I took Entresto I would be passing out! I am very slim and don't weigh alot .Although I have low blood pressure I take medication.that is given to people with high blood pressure - Cardestaran for example!
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