The effect of sacubitril/valsartan compared to olmesartan on cardiovascular remodelling in subjects with essential hypertension: the results of a randomized, double-blind, active-controlled study

Abstract

Since LV mass change correlates with cardiovascular prognosis, the greater reductions in LV mass indicate valuable advantages of sacubitril/valsartan compared to olmesartan. The finding that LV mass index decrease might be to some extent independent of SBP suggests that the effect of the dual-acting agent may go beyond those due to its BP-lowering ability.

Effects of LCZ696 (Sacubitril/Valsartan) on Blood Pressure in Patients with Hypertension: A Meta-Analysis of Randomized Controlled Trials

“…Compared with ARBs, LCZ696 200 mg caused a significant reduction in SBP (MD -4.94 mm Hg, 95% CI -6.54 to -3.35, p < 0.05), DBP (MD -2.24 mm Hg, 95% CI -2.74 to -1.75, 3). Seven studies [6,8,11,12,[14][15][16] reported SBP and DBP in LCZ696 400 mg and ARBs. Four studies [6,8,11,12] reported 24 h ASBP and 24 h ADBP in LCZ696 400 mg and ARBs.…”

“…Twelve studies reported SBP and DBP [6][7][8][9][10][11][12][13][14][15][16][17]. Eight studies reported 24 h ASBP and 24 h ADBP [6][7][8][9][10][11][12][13].…”

Prognostic Implications of Left Ventricular Hypertrophy

“…Despite a modest decrease in SBP, but not DBP, in the sacubitril/valsartan arm, they did find significant reductions in LVM index (-6.83 vs. -3.55 g/m2, p<0.029). 136 In contrast to these positive results, recent studies of alternative therapies such as renal denervation or long acting nitrates have shown no benefit in the reduction of LVH. 137,138 Conclusion LVH has been one of the most well studied clinical variables over the past 50 years of CVD research.…”

Will we ever use angiotensin receptor neprilysin inhibition (ARNi) for the treatment of hypertension?

“…In a clinical trial in patients with hypertension LCZ696 (sacubitril/valsartan) was shown to have greater BP lowering capacity and similar tolerability compared with stand-alone valsartan treatment [3]. Supported by a strong body of preclinical evidence, more recent clinical studies have demonstrated additional favourable effects of LCZ696 on deleterious cardiovascular remodelling compared to single RAAS blockade [4]. Despite these encouraging data, no adequately powered clinical outcome trial of LCZ696 for the treatment of uncomplicated hypertension is currently being conducted or planned.…”

“…Moreover, NEP inhibition acts as a "natural" diuretic without impact on serum potassium and serum uric acid. In light of the documented BP-lowering effect, more potent than that of the ARB alone [3,6], and safety of LCZ696 [3,4], the lack of clinical outcome studies, and underutilization of the novel ARNi drug class in hypertension is a major lost opportunity. The BP lowering effects of LCZ696 would likely be further enhanced in combination with a thiazide diuretic, as has been shown with other RAAS-inhibitors, further enhancing its potential utility for the treatment of difficult to manage hypertension.…”