Treatment with ARNIs for Cardiovascular Diseases – Dr Pramod Kumar K
ARNI (Angiotensin receptor-neprilysin inhibitor) is a new class of medication used in Heart Failure treatment.
1. What is Heart failure?
Heart failure is the inability of the heart to pump the blood according to the needs of the body. This may happen either suddenly or over a period of time.
It may be because of various factors such as uncontrolled hypertension, uncontrolled diabetes, history of heart attacks, previous history of bypass surgery or stents, it could be because of other reasons like pregnancy related or viral infections etc.
All of these factors cause an increase in the diameter of the heart or size of the heart and decrease the heart function which will manifest as Heart failure indicating shortness of breath while walking, swelling of legs and inability to sleep comfortably. The patient may have to wake up because of breathlessness along with other symptoms such as fatigue which makes the patient unable to perform daily activities.
2. Are there any ARNI effective new medications?
Recently there are many medications to help patients in Heart failure, so “Angiotensin receptor inhibitor Neprilysin inhibitor” or ARNIs are the new class of medications that has come into the practice for Heart failure management.
Apart from these, there are some new medications called SGLT inhibitors that are used for Diabetes. They also help patients with Heart failure. There are also traditional medications which are useful for the management of Heart failure.
3. What is ARNI, How does it work?
ARNIs is a new class of medication that is used for the management of Heart failure. It is an Angiotensin receptor Neprilysin inhibitor which is a combination of 2 medications one is Neprilysin inhibitor and other one is Angiotensin receptor blocker. Natriuretic peptides are the substances produced in the body to increase the diuresis and produce decongestion which helps heart failure to improve, but Neprilysin degrades these Natriuretic peptides. Neprilysin inhibitor is a new compound that helps to increase the level of Neprilysin and thereby helps the Heart failure to be managed. The angiotensin receptor neprilysin inhibitor also blocks the angiotensin II type-1 receptor. This combination is very effective in managing Heart Failure.This is called the ARNI concept.
4. Does ARNI help in heart failure?
The ARNI medications are very helpful in Heart failure. There is volume overload in Heart failure that means the body is unable to excrete the water and salt and therefore the patient has a lot of water retention in the body resulting in increase in the body weight and shortness of breath.
If the condition is left untreated, there can be two main problems. The body accumulates water more and more, especially in the lungs and abdomen. To eliminate this condition, a Diuretic is recommended which increases urination and thereby the body weight decreases and the overall volume decreases.
The ARNIs also help in preventing Renin Angiotensin mechanism which helps to regulate the fluids in the body thereby decreasing heart rate to some extent. It also prevents the water accumulation in the body.
5. Does ARNI affect blood pressure & sugar?
Yes, ARNIs affect blood pressure. These medications aid in the reduction of blood pressure helping to manage Hypertension in patients with Heart Failure. Besides, this class of medication does not have any effect on blood sugar levels. Unlike other medications used for Heart Failure, ARNIs does not cause Diabetes.
6. At what age can patients use it?
According to the Literature and studies available, it can be used for patients up to the age of 75 years. But, beyond 75 years of age proper caution should be taken when these medications are used in patients with the Heart failure.
7. What is the dose and its side effects? How to monitor?
There are currently three available dosages taken twice daily:
Generally, these medications are administered at lower doses of 50 mg twice a day and we gradually increase the dose over a period of 3-4 weeks until the maximum tolerated dose is achieved. Every medication has some side effects, similarly this particular compound has got some side effects. One of the side effects is reduction in the blood pressure and if overdose is given, the patient may have a significantly low blood pressure and may have symptoms of dizziness, fatigue etc. These can also produce dry cough in some patients. While the patient is under these medications, kidney parameters should be monitored.
This medication should not be used in patients with severe kidney diseases. It can be carefully administered in selected patients, yet the serum Creatinine and potassium levels need to be monitored periodically. In patients with severe kidney failure ARNIs should be avoided.
8. Do ARNIs affect memory?
Initially, there are some doubts raised that this medication may cause some problems with memory. But it is found to be useful and doesn’t affect the cognition. In fact, it may be useful for patients who have Alzheimer’s disease. There are ongoing studies reporting neurological benefits of this medication.
9. What other medications should be used?
Along with ARNI, there are other medications that are available for the management of heart failure. The first class of medications that can be used for Heart failure are Diuretics, Beta blockers and mineralocorticoid antagonists. Lanoxin is one of the oldest medications that can be used. Depending on the patient’s condition any of these medications can be prescribed for the treatment of Heart Failure.
A patient with heart failure is given a concomitant class of medications. For acute heart failure, these medications are administered in smaller doses. Other medications such as injectable medications are infused into the venous system of the patient in ICU. Subsequently, these are replaced with newer medications for better functioning of the heart. This can avoid recurrent hospitalization of the patient thereby reducing the expenses and managing symptoms of Heart Failure.
10. Are other therapies for Heart failure available in Yashoda Hospitals?
At Yashoda Hospitals, other therapies which are more useful for patients with recurrent hospitalization or Refractory Heart Failure are available. A device similar to a pacemaker which is called a CRT device is implanted for selected patients. There are also assist devices which are recommended for Heart Failure, yet this can be an expensive procedure. Heart Transplantation can also be done in patients with severe Refractory Heart Failure.
Patient safety being our first priority, we try to prolong the requirement for the transplantation as much as possible by using optimal medication therapy and newer medications so that the patient can be managed conservatively with medical follow- ups and frequent checkups as much as possible. If the medication does not have any effect, then we recommend Invasive device implantation or cardiac transplantation. The dosage of the medication is very important and has to be decided by the Doctor.