Key result
Sacubitril/valsartan plus 10 mg amlodipine lowers SBP by ~16 mmHg vs monotherapy.
Why the study?
The study aimed to demonstrate a superior blood pressure-lowering effect of sacubitril/valsartan and amlodipine combination therapy versus sacubitril/valsartan monotherapy in Japanese patients with grade I/II essential hypertension inadequately controlled on monotherapy.
Does sacubitril/valsartan combined with amlodipine reduce mean sitting systolic blood pressure in Japanese patients with essential hypertension inadequately controlled on sacubitril/valsartan monotherapy?
RCT (n=717)
Double-blind
parallel-group
Yes
Does sacubitril/valsartan combined with amlodipine reduce mean sitting systolic blood pressure in Japanese patients with essential hypertension inadequately controlled on sacubitril/valsartan monotherapy?
Adding amlodipine to sacubitril/valsartan provides superior, dose-dependent blood pressure reduction with favorable safety in patients with essential hypertension inadequately controlled by sacubitril/valsartan monotherapy.
May support adding amlodipine to SacVal for better control in uncontrolled hypertension; extends dual-therapy evidence in Japanese patients.
This multicenter, randomized, double-blind, parallel-group, active-controlled study aimed to demonstrate a superior BP-lowering effect of sacubitril/valsartan (SacVal) and amlodipine (AML) combination therapy vs SacVal monotherapy in Japanese patients with grade Ⅰ/Ⅱ essential hypertension inadequately controlled with SacVal monotherapy. After 4 weeks of single-blind active run-in with SacVal 200 mg monotherapy, patients (n=717) with mean sitting systolic blood pressure (msSBP) of 140 to <180 mmHg were randomized and received SacVal 200 mg monotherapy or SacVal 200 mg in combination with AML (2.5, 5, or 10 mg) for 8 weeks. All SacVal/AML 200 mg/2.5 mg, 200 mg/5 mg, 200 mg/10 mg combinations achieved statistically significant, dose-dependent reductions in msSBP vs SacVal 200 mg monotherapy (treatment difference [mmHg] [95% CI]: −5.63 [ −8.01, −3.25], −12.94 [ −15.22, −10.67], −16.39 [ −19.01, −13.77], respectively; all p < 0.001). Treatment effects of all combinations were also statistically significant in 24-h ambulatory SBP (treatment difference [mmHg] [95% CI] vs SacVal: −6.48 [ − 8.79, −4.18], −14.18 [ −16.63, −11.73], −17.70 [ −20.24, −15.26], respectively; all p < 0.001) and BP control ( < 140/90 mmHg) rates (57.2, 72.5, 79.9%, respectively, vs 35.0% in SacVal with odds ratio [95% CI]: 2.16 [1.40, 3.33], 5.28 [3.31, 8.43], 7.23 [4.41, 11.86], respectively; all p < 0.001). Subgroup and waterfall plot analyses in msSBP demonstrated consistent BP-lowering effects across patient demographic and baseline characteristics. The safety profile of combination therapy was similar to that of SacVal with no new safety findings. These results demonstrated that combination therapy provided superior BP reduction with favorable safety and tolerability in Japanese patients inadequately controlled by SacVal 200 mg monotherapy.
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Kario et al. (2026) conducted an RCT in grade Ⅰ/Ⅱ essential hypertension (n=717). Sacubitril/valsartan and amlodipine vs. SacVal 200 mg monotherapy was evaluated on reduction in mean sitting systolic blood pressure (msSBP) (MD -16.39, 95% CI -19.01 to -13.77, p=<0.001). Sacubitril/valsartan combined with amlodipine (10 mg) provided superior reduction in mean sitting systolic blood pressure compared to monotherapy (MD -16.39 mmHg; 95% CI -19.01 to -13.77; P<0.001).
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