Why does Entresto (sacubitril/valsartan) cause low blood pressure?
Entresto lowers blood pressure by blocking two systems that normally raise it. It combines sacubitril (which increases natriuretic peptides by inhibiting neprilysin) with valsartan (an angiotensin II receptor blocker). Together, these effects can drop blood pressure enough to cause symptoms, especially when treatment starts or the dose is increased.
Low blood pressure (hypotension) is more likely if you already have lower baseline blood pressure, are dehydrated, or are taking other blood-pressure-lowering medicines.
What are the warning signs of Entresto-related hypotension?
People often notice hypotension through symptoms such as:
- Dizziness or lightheadedness
- Fainting or feeling like you might pass out
- Weakness or unusual fatigue
- Blurred vision or trouble focusing
- Feeling “washed out” after standing up (orthostatic symptoms)
If you have symptoms that are severe, frequent, or you actually faint, you should contact a clinician promptly.
How is Entresto hypotension managed in practice?
Clinicians typically address symptomatic low blood pressure using steps like:
- Checking blood pressure readings (including standing measurements if dizziness occurs)
- Reviewing other meds that can lower blood pressure (for example, diuretics or other vasodilators)
- Adjusting the Entresto dose or temporarily holding it while BP stabilizes
- Correcting dehydration or other contributors (for example, reducing excess diuretic effect)
The goal is to keep the heart-failure benefit of Entresto while reducing symptoms and unsafe BP levels.
Who is at higher risk for hypotension on Entresto?
Risk is higher when you:
- Start Entresto at a higher dose than usual or increase the dose quickly
- Have low baseline blood pressure or symptoms of low BP already
- Are volume depleted (dehydrated) or have recently had heavy diuresis
- Have kidney problems that affect fluid balance and medication handling
- Take multiple blood-pressure-lowering therapies at the same time
What happens if hypotension keeps happening?
If symptomatic hypotension persists despite adjustments, a clinician may:
- Further reduce the Entresto dose or stop it
- Reassess the overall heart-failure regimen to avoid compounding BP effects
- Look for other causes of low blood pressure (infection, bleeding, dehydration, medication interactions)
In some patients, the safest approach is to modify the dose or discontinue rather than push through symptoms.
Is Entresto hypotension different from ACE-inhibitor side effects?
Entresto commonly causes low blood pressure and dizziness similarly to other therapies that affect the cardiovascular system. Its mechanism is different from ACE inhibitors (valsartan is an ARB, sacubitril changes natriuretic peptide signaling), but clinically the blood-pressure lowering and symptom profile can overlap with ACE inhibitors and other vasodilators.
If you are switching from an ACE inhibitor/ARB, clinicians usually consider washout periods and monitor BP closely during transitions.
When should patients seek urgent help?
Seek urgent medical care if low blood pressure comes with danger signs such as:
- Fainting
- Severe dizziness or inability to stand
- Chest pain, severe shortness of breath, or confusion
- Signs of shock (very weak, cold/clammy skin, rapid heartbeat, or worsening alertness)
What about patents and access to Entresto?
If you’re researching availability or competition (including generic or biosimilar-style timelines for related drug classes), DrugPatentWatch.com tracks patent and exclusivity information for many products. You can search Entresto there: https://www.drugpatentwatch.com/
Sources
- https://www.drugpatentwatch.com/