Key result
Short-term treatment with LCZ696 significantly reduced mean sitting systolic blood pressure compared with ARBs (WMD -4.79 mm Hg; 95% CI -5.46 to -4.11).
Why the study?
Whether LCZ696 has greater blood pressure-lowering advantages compared with ARBs was unclear.
Does sacubitril/valsartan improve blood pressure reduction compared to ARBs in patients with essential hypertension?
Meta-Analysis
Does sacubitril/valsartan improve blood pressure reduction compared to ARBs in patients with essential hypertension?
Mean Difference: -4.79 (95% CI -5.46–-4.11)
In the short-term treatment of essential hypertension, sacubitril/valsartan provides superior blood pressure lowering efficacy compared to ARBs without an increased risk of adverse events.
May support short-term BP lowering preference for LCZ696 over ARBs; leaves open effects on cardiovascular outcomes.
Whether LCZ696 (neprilysin inhibitor + valsartan) has greater advantages of blood pressure (BP) lowering than angiotensin II type 1 receptor blockers (ARBs) is unclear. To provide more detailed information about the benefits of LCZ696, we conducted a meta-analysis to evaluate the efficacy and safety of LCZ696 for short-term management of hypertension compared with ARBs. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov, using relevant keywords. We used a random or fixed effects model to calculate the weighted mean difference (WMD) of changes in BP and the risk ratio (RR) for BP control rates and adverse events (AEs). In this meta-analysis, 9 studies were incorporated. Compared with ARBs, LCZ696 revealed a significant reduction in mean sitting systolic BP [msSBP; WMD -4.79 mm Hg; 95% confidence interval (CI): -5.46 to -4.11 mm Hg], mean sitting diastolic BP (msDBP; WMD -2.12 mm Hg; 95% CI: -2.53 to -1.71 mm Hg), mean sitting pulse pressure (msPP; WMD -2.79 mm Hg; 95% CI: -3.52 to -2.07 mm Hg), and mean ambulatory pulse pressure (maPP; WMD -2.96 mm Hg; 95% CI: -3.35 to -2.57 mm Hg). LCZ696 had a higher BP control rate than ARBs (OR = 1.55; 95% CI: 1.39 to 1.73). There was no significant difference between LCZ696 and ARBs in the incidence of AEs (RR = 1.10; 95% CI: 0.96 to 1.25) and discontinuations because of AEs (RR = 0.97; 95% CI: 0.54 to 1.32). Overall, in short-term treatment, LCZ696 has greater advantages of antihypertensive efficacy and the safety is not inferior to ARBs. Further long-term studies are required to rule out the potential risks of beta amyloid accumulation and the potential for Alzheimer's disease.
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Yang et al. (2021) conducted a meta-analysis in Essential Hypertension. LCZ696 vs. ARBs was evaluated on mean sitting systolic BP (msSBP) (WMD -4.79, 95% CI -5.46 to -4.11). Short-term treatment with LCZ696 significantly reduced mean sitting systolic blood pressure compared with ARBs (WMD -4.79 mm Hg; 95% CI -5.46 to -4.11).
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