Sacubitril/valsartan outdoes valsartan on ventricular remodeling in perimenopausal hypertension
14 Jun 2023
Treatment with sacubitril/valsartan appears to be better than valsartan alone in reversing ventricular remodeling in perimenopausal hypertensive women, suggests a study.
A total of 292 women with perimenopausal hypertension were analysed in this prospective, randomized, actively controlled, open-label study. Participants were randomly assigned to receive either sacubitril/valsartan 200 mg once daily or valsartan 160 mg once daily for 24 weeks.
The investigators assessed the relevant indicators of ambulatory blood pressure (BP), echocardiography, and myocardial fibrosis regulation at baseline and at 24 weeks.
At week 24, the 24-h mean systolic (S)BP was 120.08 mm Hg in the sacubitril/valsartan group and 121.00 mm Hg in the valsartan group (p=0.457). No significant difference was also seen in central SBP between the two treatment groups after 24 weeks of treatment (117.17 vs 116.38 mm Hg; p=0.568).
Left ventricular mass index (LVMI) was lower in the sacubitril/valsartan group than that in the valsartan group at week 24 (p=0.009). Specifically, LVMI decreased by 7.23 g/m2 from baseline in the sacubitril/valsartan group and by 3.70 g/m2 in the valsartan group (p=0.000 vs p=0.017).
After adjusting for the baseline LVMI, a statistically significant difference in LVMI was noted between the two treatment groups at week 24 (p=0.001).
Notably, patients who received sacubitril/valsartan had reduced levels of α-smooth muscle actin (α-SMA; p=0.000), connective tissue growth factor (CT-GF; p=0.005) and transforming growth factor-β (TGF-β; p=0.000) relative to baseline levels.
At 24 weeks, the LVMI was statistically significant between the two groups after correcting for confounding factors, such as 24-h mean SBP and 24-h mean diastolic BP (p=0.005).
The LVMI, serum TGF-β, α-SMA, and CT-GF remained statistically significant between the two groups after further correcting for age, body mass index, and sex hormone levels (p<0.05).
“The different effects of these two therapies on ventricular remodeling in perimenopausal hypertensive women might be because of their different effects on the down-regulation of fibrosis-related factors,” the investigators said.