Key result
LCZ696 lowers SBP by ~4 mmHg more than ACEI or ARB in essential hypertension.
Why the study?
Does sacubitril/valsartan reduce systolic blood pressure in patients with mild-moderate essential hypertension compared to ACEI or ARB?
Meta-Analysis (n=8,996)
Does sacubitril/valsartan reduce systolic blood pressure in patients with mild-moderate essential hypertension compared to ACEI or ARB?
Mean Difference: -3.89 (95% CI -7.75–-0.04)
p-value: p=0.05
In a meta-analysis of 3 RCTs, sacubitril/valsartan provided a statistically significant but modest additional reduction in systolic blood pressure compared to ACEI or ARB in patients with mild-moderate essential hypertension.
Modest additional SBP reduction unlikely to change hypertension practice; extends RCT evidence on BP lowering without outcome data.
Introduction: LCZ696 is a first-in-class inhibitor of the angiotensin II receptor and Neprilysin. The use of LCZ696 in Heart Failure is promising compared to ACEI or ARB. The use of LCZ696 for blood pressure has been studied but controversial. We performed a meta-analysis of randomized controlled trials (RCTs) comparing LCZ696 to ACEI/ARB for lowering systolic blood pressure effect. Objectives: To assess the efficacy of LCZ696 on systolic blood pressure in comparison to angiotensin-converting-enzyme inhibitor (ACEI)/Angiotensin II receptor antagonist (ARB). Methods: We searched PubMed, Medline, Embase and Cochrane for prospective RCTs that compared LCZ696 versus ACEI or ARB in patients with established diagnosis of essential hypertension. Trials that included patients with essential hypertension with or without heart failure were randomized to either LCZ696 or ACEI or ARB, and that also reported at least one of the studied outcomes were included. Study quality was assessed using the Jadad score. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. Mean differences were calculated using the random effect model. Results: Three RCTs met our inclusion criteria and included 8996 patients who had mild-moderate essential hypertension and were between18-75 years. They were randomized to LCZ696 versus ACEI or ARB. The use of LCZ696 was associated with improved systolic blood pressure control when compared to the control group (MD -3.89; 95% CI -7.75, -0.04; P=0.05). Conclusions: Our findings suggest that the use of LCZ696 in hypertensive patients provides better reduction of blood pressure when compared to an ACEI or an ARB.
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Alrifai et al. (2015) conducted a meta-analysis in essential hypertension (n=8,996). LCZ696 vs. ACEI or ARB was evaluated on systolic blood pressure (MD -3.89, 95% CI -7.75, -0.04, p=0.05). LCZ696 provided better reduction of systolic blood pressure compared to an ACEI or ARB in patients with essential hypertension (MD -3.89; 95% CI -7.75, -0.04; P=0.05).
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