Entresto was recommanded by major guidelines as the frontline therapy for heart 
failure with reduced ejection fraction since its clinical benefit was proved by 
the PARADIGM-HF trial. Angiotensin converting enzyme inhibitors are the 
cornerstone of the treatment of HF. Varying incidences of first-dose hypotension 
have been reported and recognized as a potential limiting factor for 
prescribing. According to previous reports, the onset of hypotension mostly 
occur 3-5 hours after the first dose. However, the pattern of entresto-related 
hypotension has not been reported. We present a case of HF, who had delay onset 
(about 8 to 18 hours) and prolonged (3 to 6 days) first-dose hypotension. 
Further investigation is required to illustrate this phenomenon.