Sacubitril/Allisartan 480 mg/day provided greater reductions in nighttime systolic blood pressure compared with Olmesartan 20 mg/day (MD -10.9 mmHg; 95% CI -16.1 to -5.8; P<0.0001).
RCT (n=338)
Does sacubitril/allisartan reduce blood pressure compared to olmesartan in elderly Chinese patients with mild to moderate hypertension?
Sacubitril/Allisartan provides dose-dependent and greater blood pressure reductions, particularly in nighttime ambulatory blood pressure, compared to olmesartan in elderly Chinese hypertensive patients.
Mean Difference: -10.9 (95% CI -16.1–-5.8)
Absolute Event Rate: -26.2% vs -21.5%
p-value: p=<0.0001
Objective: Sacubitril/Allisartan, a novel angiotensin receptor-neprilysin inhibitor, has demonstrated antihypertensive efficacy in the patients with hypertension. Its effects in the elderly patients, who often present with increased arterial stiffness and comorbidities, remain less understood. Design and method: We performed analysis of data from a randomized clinical trial that compared the blood pressure-lowering effect at 12 weeks of treatment with Sacubitril/Allisartan (240 or 480 mg/d) and Olmesartan (20 mg/d). Eligible patients with mild to moderate hypertension and aged 65-75 years old were included in the analysis. The primary outcome was change in clinic and 24-h ambulatory blood pressure from baseline to week 12. Results: Of the 1197 randomized patients, 338 (41.5%) elderly patients (mean age 67.9 ± 2.3 years; 49.9% male) were included in this analysis. Baseline characteristics were comparable among treatment groups. At 12 weeks, least square mean (±standard error) changes from baseline in clinic systolic/diastolic blood pressure in Sacubitril/Allisartan 240 and 480 mg/day and Olmesartan 20 mg/day groups were -24.0 ± 1.6/-5.7 ± 0.9, -26.2 ± 1.6/-6.5 ± 0.9 mmHg, and -21.5 ± 1.6/-6.3 ± 0.9 mmHg, respectively. Greater reductions were also observed with Sacubitril/Allisartan 480 mg/day compared with Olmesartan 20 mg/day in 24-h, daytime and nighttime systolic blood pressure (P<=0.02). The reductions in ambulatory blood pressure were dose-dependent (P<=0.02), and significantly greater with Sacubitril/Allisartan 480 mg compared with Olmesartan 20 mg for nighttime blood pressure (-17.5±1.8/8.1±1.0 mmHg, with a difference of -10.9 -16.1 to -5.8 mmHg, P<0.0001 for systolic and -4.5 -7.3 to -1.8 mmHg, P=0.002 for diastolic). Conclusions: In elderly patients with hypertension, Sacubitril/Allisartan provided dose-dependent greater blood pressure reductions compared with Olmesartan.
Zhang et al. (Fri,) conducted a rct in mild to moderate hypertension (n=338). Sacubitril/Allisartan vs. Olmesartan 20 mg/d was evaluated on change in clinic and 24-h ambulatory blood pressure from baseline to week 12 (MD -10.9, 95% CI -16.1 to -5.8, p=<0.0001). Sacubitril/Allisartan 480 mg/day provided greater reductions in nighttime systolic blood pressure compared with Olmesartan 20 mg/day (MD -10.9 mmHg; 95% CI -16.1 to -5.8; P<0.0001).