HF drug provides 24-hour BP-lowering effect in Asians with hypertension

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan, used for heart failure, appears to have potent effects on 24‐hour blood pressure (BP) in Japanese patients with mild‐to‐moderate hypertension and in the subgroup of those with nondipping BP pattern, as shown in a study.

Researchers conducted a post hoc analysis of data from a randomized clinical trial in which the BP‐lowering effects of 8 weeks of treatment with sacubitril/valsartan (200 or 400 mg/d) were compared with those of olmesartan (20 mg/d). Outcomes were compared in subgroups defined by nocturnal BP status.

The analysis included 632 Japanese patients (54 percent of total population; mean age 58.7 years, 69.5 percent men, mean BMI 25.6 kg/m²), among whom 216 received sacubitril/valsartan 200 mg, 216 received sacubitril/valsartan 400 mg, and 200 received olmesartan.

The primary endpoint of changes in 24‐hour, daytime, and night-time BP over 8 weeks of treatment were significantly greater with both sacubitril/valsartan doses than with olmesartan, regardless of dipping status. The proportion of patients who achieved an ambulatory BP reduction of ≥5 mm Hg was 83 percent and 85 percent in the sacubitril/valsartan 200- and 400-mg groups, respectively, and 58 percent in the olmesartan group.

Of note, the reductions in night-time systolic BP were greater in the nondipper group (sacubitril/valsartan 200 and 400 mg vs olmesartan: difference, –4.6 and −6.8 mm Hg, respectively; p<0.01 and p<0.001). Systolic BP control rate was also more favourable for nondippers who received either dose of sacubitril/valsartan than for their counterparts who received olmesartan (34.4 percent with 200 mg and 42.6 percent with 400 mg vs 23.1 percent).