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Sacubitril/valsartan combo superior to olmesartan for lowering BP

Sacubitril/valsartan combo superior to olmesartan for lowering BP
China: Treatment with sacubitril/valsartan 200 or 400 mg once daily provided effective and superior reduction of blood pressure (BP) compared with olmesartan 20 mg in Asian patients having mild‐to‐moderate hypertension, according to a new study published in the Journal of Clinical Hypertension. The combo drug was also safe and well tolerated in the patients.
Hypertension, a major risk factor for cardiovascular disease is a leading cause of morbidity and mortality worldwide with an estimated prevalence of 1 billlion adults, which is expected to increase to 1.5 billion by 2025. The prevalence of hypertension in Asian countries  ranges from 30% in Korea to 39% in China. Because of a rapid increase in the aging population, the incidence of hypertension in Asia is expected to increase.
Sacubitril/valsartan, a first‐in‐class angiotensin receptor neprilysin inhibitor (ARNI) that provides simultaneous neprilysin inhibition and angiotensin receptor blockade, was recently approved for the treatment of chronic heart failure with reduced ejection fraction, based on its superior benefits over enalapril in the PARADIGM‐HF trial.
Yong Huo, Department of Cardiology and Heart Center, Peking University First Hospital, Beijing, China, and colleagues assessed the efficacy and safety of angiotensin receptor neprilysin inhibitor sacubitril/valsartan vs olmesartan in Asian patients with mild‐to‐moderate hypertension.
For the study, the researchers examines 1438 patients having mild‐to‐moderate hypertension; from which 479 patients were randomly assigned to receive once daily sacubitril/valsartan 200, 473 patients received sacubitril/valsartan 400 mg and 486 received olmesartan 20 mg. Reduction in mean sitting systolic BP (msSBP) and mean sitting diastolic BP (msDBP), clinic and mean ambulatory BP (maSBP, maDBP, and mean ambulatory pulse pressure [maPP]), and mean daytime/nighttime maSBP and maDBP in a subgroup of patients with ambulatory blood pressure monitoring (ABPM) from baseline to 8 weeks were compared between 3 treatment groups.
Key Findings:
  • At 8 weeks, sacubitril/valsartan 200 mg and 400 mg showed significantly greater reduction in msSBP vs olmesartan 20 mg.
  • Sacubitril/valsartan 200 mg showed greater reductions in msDBP and msPP  vs olmesartan 20 mg.
  • Sacubitril/valsartan 200 mg showed significant reductions in nighttime maSBP and maDBP vs olmesartan 20 mg.
  • Significant reduction was seen in maSBP and maDBP with sacubitril/valsartan 400 mg vs olmesartan 20 mg.
  • Both the doses of sacubitril/valsartan also showed reduction in msSBP and msDBP in elderly patients and patients with isolated systolic hypertension.
  • Both sacubitril/valsartan 200 mg and 400 mg showed reductions in 24‐hour maSBP from baseline to week 8 vs olmesartan 20 mg.
  • Compared with olmesartan 20 mg, sacubitril/valsartan 200 mg and 400 mg showed reduction in 24‐hour maDBP.
  • Both doses of sacubitril/valsartan showed significant reduction in maPP vs olmesartan.

Also Read: Management of High Blood Pressure – Latest 2018 ESC/ESH Guidelines

“Reductions in nighttime BP observed in this study could be attributed to increased natriuretic peptides‐mediated mechanism due to neprilysin inhibition by sacubitril/valsartan.” write the authors.
Considering the higher prevalence of non‐dippers among Asian patients and the strong correlation between nighttime BP and adverse cardiovascular risks, our finding suggests that treatment with sacubitril/valsartan is beneficial in Asian patient with hypertension, especially in the elderly,” they further added.
“This 8‐week study showed that sacubitril/valsartan 200 mg and 400 mg once daily provided significantly greater BP reductions, particularly nighttime BP reductions, vs olmesartan 20 mg in Asian patients with mild‐to‐moderate systolic hypertension. All the study treatments are generally well tolerated. A pre‐specified subgroup analysis of the Chinese population also showed that sacubitril/valsartan was generally safe and efficacious for treating mild‐to‐moderate essential hypertension,” concluded the authors.
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Source: With inputs from Journal of Clinical Hypertension

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