Key result
Sacubitril/valsartan linked to ~5.5 g/m2 LVMI reduction vs ACEi/ARB in hypertensive hemodialysis patients.
Why the study?
Left ventricular hypertrophy is highly prevalent and predicts mortality in maintenance hemodialysis patients, but the comparative efficacy of sacubitril/valsartan versus ACEi/ARB on ventricular remodeling was unclear.
Does sacubitril/valsartan improve left ventricular mass index in hypertensive patients undergoing maintenance hemodialysis compared to ACEi/ARB?
Cohort (n=111)
No
Does sacubitril/valsartan improve left ventricular mass index in hypertensive patients undergoing maintenance hemodialysis compared to ACEi/ARB?
Effect estimate: mean difference −5.52 g/m2 vs. 1.11 g/m2; ANOVA Group × Time interaction P=0.033 (95% CI −9.35 to −1.69 in SV group; −3.27 to 5.50 in ACEi/ARB group)
Absolute Event Rate: -5.52% vs 1.11%
p-value: p=0.006 for SV group, 0.615 for ACEi/ARB group
Sacubitril/valsartan is more effective than ACEi/ARB in reversing left ventricular hypertrophy in hypertensive patients on maintenance hemodialysis, despite achieving similar blood pressure reductions.
May warrant sacubitril/valsartan preference over ACEi/ARB to reverse LVH in hypertensive HD patients; extends evidence to maintenance hemodialysis cohort.
Background Left ventricular hypertrophy (LVH), a hallmark of pathological ventricular remodeling, is highly prevalent and strongly predicts mortality in patients undergoing maintenance hemodialysis (MHD). This study aimed to compare the efficacy of sacubitril/valsartan (SV) vs. angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) on ventricular remodeling in hypertensive MHD patients. Methods In this single-center retrospective cohort study conducted between January 2023 and June 2025, 111 hypertensive patients undergoing MHD for at least 3 months were divided into SV ( n = 46) and ACEi/ARB ( n = 65) groups based on their antihypertensive regimen. The primary endpoint was the change in left ventricular mass index (LVMI) after 6 months. Secondary endpoints included changes in blood pressure, other echocardiographic parameters, NT-proBNP, and safety outcomes. Results The mean age was 56.17 ± 13.47 years and 68.5% were male. After 6 months, LVMI significantly decreased in the SV group (−5.52 g/m 2 , 95% CI −9.35 to −1.69, P = 0.006) but not in the ACEi/ARB group (1.11 g/m 2 , 95% CI −3.27 to 5.50, P = 0.615). Two-way repeated measures ANOVA revealed a significant group × time interaction for LVMI ( P = 0.033). Both groups achieved significant blood pressure reductions: systolic blood pressure decreased by 9.81 mmHg ( P < 0.001) in the ACEi/ARB group and by 10.46 mmHg ( P < 0.001) in the SV group. New-onset intradialytic hypotension occurred in 7 (6.3%) patients and hyperkalemia in 9 (8.1%) patients, with similar incidences between groups and no treatment discontinuations. Conclusions Compared to ACEi/ARB, SV is more effective in reversing ventricular remodeling in hypertensive MHD patients.
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Jiang et al. (2026) conducted a cohort in Hypertensive patients undergoing maintenance hemodialysis for end-stage renal disease (n=111). sacubitril/valsartan vs. angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was evaluated on Change in left ventricular mass index (LVMI) from baseline to 6 months (mean difference −5.52 g/m2 vs. 1.11 g/m2; ANOVA Group × Time interaction P=0.033, 95% CI −9.35 to −1.69 in SV group; −3.27 to 5.50 in ACEi/ARB group, p=0.006 for SV group, 0.615 for ACEi/ARB group). Sacubitril/valsartan reduced left ventricular mass index by 5.52 g/m2 compared to no significant change with ACEi/ARB over 6 months in hypertensive maintenance hemodialysis patients (Group × Time interaction P=0.033).
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