When should ARNI be avoided according to clinical guidelines?

ARNI (Angiotensin Receptor Neprilysin Inhibitor) is a medication used primarily for heart failure management. According to clinical guidelines, ARNI should be avoided when systolic blood pressure (SBP) is under 100 mmHg. This is due to the fact that ARNI can lead to hypotension as a side effect, and initiating it in a patient with already low blood pressure can increase the risk of further lowering blood pressure, potentially leading to adverse events.

In patients with SBP less than 100, the risks associated with hypotension outweigh the benefits of initiating ARNI therapy. Ensuring adequate blood pressure is critical before starting any antihypertensive or heart failure medication to maintain hemodynamic stability.

The other options relate to different clinical parameters but are not associated with the contraindications for initiating ARNI therapy in the same way. For instance, while a low heart rate might require caution, it's not an absolute contraindication. Similarly, renal function, indicated by creatinine clearance (CrCl), is important but a CrCl below 30 mL/min generally suggests a need for careful monitoring rather than outright avoidance of ARNI.