Does Entresto lower blood pressure?

In this article:

• Entresto and blood pressure
• Efficacy for blood pressure management
• How quickly does it work
• Can Entresto cause hypotension?
• The bottom line

In this article

• Entresto and blood pressure
• Efficacy for blood pressure management
• How quickly does it work
• Can Entresto cause hypotension?
• The bottom line

Entresto tablets contain two drugs: valsartan and sacubitril. This combination allows your heart to pump blood more efficiently, managing certain types of heart failure in adults and children older than 1, and helping to lower the risk of death and hospitalization.

Entresto belongs to a class of drugs called angiotensin receptor neprilysin inhibitors (ARNIs). Decreased blood pressure is a side effect of Entresto. However, it’s not prescribed to treat hypertension (high blood pressure).

Can Entresto lower blood pressure?

Entresto is not prescribed to treat high blood pressure. However, “a side effect of Entresto is lower blood pressure,” explains Leonard Pianko, MD, a cardiologist based in Aventura, Florida. That’s because valsartan, one of the active ingredients in Entresto, is a blood pressure medication.

“Entresto works by relaxing blood vessels, thereby lowering both diastolic and systolic blood pressure,” agrees Paul Daidone, MD, a double board-certified internist based in Rogers, Arkansas. “This decrease in blood pressure reduces the workload on the heart, allowing it to operate more efficiently. However, the degree to which Entresto lowers blood pressure varies by individual.”

Entresto is a treatment option for the nearly 6.7 million American adults who live with heart failure—particularly for those with reduced ejection fraction. In this medical condition, the left ventricle of the heart does not pump enough blood to the rest of the body. When untreated, heart failure can lead to life-threatening problems with the liver, kidney function, or other heart conditions, including cardiac arrest.

“Blood pressure control is essential when treating chronic heart failure,” says Dr. Daidone. “High blood pressure puts more strain on the heart, which may exacerbate the signs and progression of heart failure. In addition to lowering the risk of complications, effective blood pressure management can help reduce symptoms and enhance quality of life.” However, balance is essential to prevent your blood pressure from dropping too low.

How much does Entresto reduce blood pressure?

While Entresto is not FDA approved in the U.S. for the treatment of hypertension, it does lower blood pressure. A meta-analysis of 11 randomized controlled trials found that a 200 mg dose of Entresto reduced systolic blood pressure by 4.62 mmHg and diastolic blood pressure (DBP) by 2.13 mmHg; a 400 mg dose of Entresto even further reduced systolic and diastolic blood pressure.

Another study of 632 Japanese patients found that Entresto achieved improved 24-hour blood pressure control in comparison to treatment with olmesartan alone, an angiotensin receptor blocker (ARB), particularly in patients who did not tend to drop their blood pressure overnight.

How quickly does Entresto lower blood pressure?

“The effects of Entresto on blood pressure can be noticed within hours to days of taking the medication,” says Dr. Daidone. “However, the full therapeutic effect on heart failure symptoms may take several weeks to manifest fully. During the initial phase of treatment, healthcare professionals should monitor you closely.” To avoid your blood pressure dropping too low, your provider will likely start you on the lowest dose of Entresto, then adjust if needed.

Can Entresto cause too low blood pressure?

One of the most common side effects of Entresto is dangerously low blood pressure, which could further complicate existing heart disease.

“Taking Entresto may increase your risk of developing hypotension,” says Dr. Daidone. “This is especially important for patients who already have low blood pressure, are taking other antihypertensive medications, or have a condition that makes them susceptible to hypotension.” For example, people who are being treated with high doses of diuretics are at a higher risk of developing hypotension while taking Entresto.

Low blood pressure symptoms include:

• Dizziness
• Light-headedness
• Confusion
• Weakness or tiredness
• Shortness of breath
• Blurred vision
• Nausea
• Heart palpitations
• Fainting

Other rare but serious side effects of Entresto include:

• Kidney problems, such as kidney failure
• High potassium levels in the blood (hyperkalemia)
• Cough
• Dizziness
• Angioedema (an allergic reaction characterized by swelling of the face, lips, or tongue)

Seek medical advice from a healthcare professional immediately if you experience any of these symptoms.

Who should not take Entresto?

It may not be safe for people with certain medical conditions to take Entresto, such as:

• A history of hereditary angioedema
• Kidney or liver problems

Those who are pregnant, breastfeeding, or plan to become pregnant should not take Entresto. It carries a boxed warning for fetal toxicity. Do not take Entresto if you have ever experienced a severe allergic reaction to either of the medications it contains, such as swelling in the face, lips, tongue, or throat or trouble breathing.

You should not take Entresto with the following medications:

• Aliskiren, an antihypertensive drug
• Diuretics, including water pills
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Lithium
• Angiotensin-converting enzyme (ACE) inhibitors

Tell your healthcare provider or pharmacist about all of the medications and over-the-counter supplements you are taking to avoid dangerous drug interactions.

Lifestyle changes to control blood pressure

Controlling blood pressure is crucial for managing heart failure. These lifestyle changes to help keep your blood pressure at a healthy level:

• Making dietary changes, such as using salt substitutes and potassium supplements and eating foods high in fiber and protein
• Maintaining a healthy weight
• Getting moderate cardiovascular activity each week
• Refraining from smoking
• Limiting alcohol
• Getting adequate sleep

Just be sure to consult with your healthcare provider to make sure these changes are safe for you.

The bottom line

Decreased blood pressure is Entresto’s most common side effect. It can lower blood pressure within hours of the first dose. To avoid dangerously low blood pressure, “healthcare providers should monitor blood pressure on a regular basis and adjust dosages as needed,” explains Dr. Daidone.