Efficacy of Sacubitril/Valsartan in Hypertension

Abstract

Background: Sacubitril/valsartan (LCZ696) has progressed to be one of the most promising medication since its approval for chronic heart failure with reduced ejection fraction. Recent data have suggested a superior blood pressure control with LCZ696.Study Question: What is the antihypertensive efficacy and safety profile of sacubitril/valsartan? Data Sources: Randomized controlled trials (RCTs) comparing the efficacy and safety of LCZ696 against a placebo or angiotensin receptor blocker (ARB). RCTs were identified from a comprehensive search in PubMed, Embase, Cochrane library, and clinicaltrials.gov. Study Design:We used a change in systolic and diastolic blood pressures, both sitting as well as ambulatory, to calculate relevant effect sizes with their standard errors from the available change in mean and SD data. In addition, we also collected categorical data for the reported adverse effects from these trials. We performed a series of pairwise meta-analyses between LCZ696 versus an active comparator or a placebo.Results: Eleven RCTs with a total of 6028 participants had the relevant data available. Our meta-analysis showed that LCZ696 is an effective and a safe treatment for hypertension. It outperformed ARBs in every category, and the results are consistent across the different dosages of LCZ696. Compared with ARBs, 200 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure (DBP) by 4.62 mm Hg (95% confidence interval, 3.33-5.90, P , 0.001) and 2.13 mm Hg (95% confidence interval, 1.69-2.57, P , 0.001), respectively. Similarly, 400 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure by 5.50 mm Hg (2.94-8.07, P , 0.001) and 2.51 mm Hg (1.80-3.21, P , 0.001), respectively, in comparison with ARBs. The adverse effects with LCZ696 were not significantly higher compared with ARBs or placebo.Conclusions: Sacubitril/valsartan is more effective for the management of hypertensive patients, compared with an ARB. Long-term prospective studies are required to identify whether this result translates into morbidity and mortality benefits.

Uncontrolled arterial hypertension: main causes, features of pathogenesis and approaches to treatment

“…Двойное слепое рандомизированное контролируемое исследование PARAMETER показало, что сакубитрил/валсартан превосходит олмесартан в снижении АД у 454 пациентов [55]. Метаанализ 11 рандомизированных контролируемых исследований с участием 6028 лиц показал, что сакубитрил/валсартан более эффективен, чем блокаторы рецепторов ангиотензина, для лечения пациентов с АГ [56]. Полученные результаты диктуют необходимость дальнейшего изучения данного препарата, в том числе его использования в лечении резистентной и рефрактерной АГ.…”

Design of the SILICOFCM study: Effect of sacubitril/valsartan vs lifestyle intervention on functional capacity in patients with hypertrophic cardiomyopathy

“…However, sacubitril/valsartan was shown to be more effective for the management of hypertensive patients, compared with an angiotensin receptor blocker . Moreover, new preliminary data suggest that sacubitril/valsartan improves exercise tolerance and left ventricular wall motion, while reducing markers of left ventricular wall stress .…”

Managing Hypertension in the elderly: What’s new?

“…Sacubitril/valsartan was shown in a double-blind, randomized controlled trial to be superior to olmesartan in decreasing clinic and ambulatory central aortic and brachial pressures in 454 patients, mean age 67.7 years, with systolic hypertension and stiff arteries [ 101 ]. A meta-analysis of 11 randomized controlled trial in 6028 persons demonstrated that sacubitril/valsartan was more effective than angiotensin receptor antagonists for the treatment of patients with hypertension [ 102 ]. Sacubitril/valsartan merits investigation of management of resistant hypertension [ [101] , [102] , [103] ].…”

“…A meta-analysis of 11 randomized controlled trial in 6028 persons demonstrated that sacubitril/valsartan was more effective than angiotensin receptor antagonists for the treatment of patients with hypertension [ 102 ]. Sacubitril/valsartan merits investigation of management of resistant hypertension [ [101] , [102] , [103] ].…”