Experience of sacubitril/valsartan therapy in hypertension

Abstract

The aim of the review was to analyze the antihypertensive efficacy and safety of sacubitril/valsartan combination, a representative of a new class of angiotensin receptor-neprilysin inhibitors (ARNIs), in patients with hypertension (HTN) according to clinical trials, including randomized, and meta-analyses. Randomized clinical trials conducted in different age, ethnic and clinical cohorts of HTN patients, as well as meta-analyses showed a more significant antihypertensive effect of sacubitril/valsartan compared with monotherapy with angiotensin II receptor blockers, confirmed by office blood pressure (BP) and 24-hour BP monitoring. At grade 1-2 HTN, sacubitril/valsartan showed greater reduction in systolic and diastolic blood pressure by ~5/2 mm Hg compared to valsartan or olmesartan according to 8-12-week studies. A dose-dependent effect of sacubitril/valsartan was established. A favorable experience was obtained with sacubitril/ valsartan use in various clinical variants of HTN (refractory HTN, isolated systolic HTN in the elderly, HTN in combination with heart failure, with chronic kidney disease), as well as the successful use of sac/vals in combination with other antihypertensive drugs. In long-term studies (52 weeks) in elderly patients with HTN, the positive effects of sacubitril/valsartan in reducing central aortic pressure, systolic blood pressure at night and a decrease in pulse pressure have been shown. Several meta-analyses have shown similar tolerability profiles compared to controls and no increased risk of adverse events.