Effect of Sacubitril/Valsartan versus Angiotensin Receptor Blocker or Calcium Channel Blockers on Ambulatory Blood Pressure and Safety in Hypertensive Patients: A Meta-Analysis of Randomized Controlled Trials

Sacubitril/valsartan, the first angiotensin receptor neprilysin inhibitor (ARNIs), has antihypertensive and organ-protective effects. However, previous meta-analyses have mainly compared it with angiotensin receptor blockers (ARBs) and neglected other commonly used antihypertensive agents, while its effect on ambulatory blood pressure remains unclear. This meta-analysis aimed to evaluate the efficacy and safety of sacubitril/valsartan in patients with hypertension. We searched CNKI, Wanfang, VIP, PubMed, Embase, and the Cochrane Library from inception to June 2025 for randomized controlled trials comparing sacubitril/valsartan with ARBs or calcium channel blockers (CCBs). Fifteen studies involving 4,824 hypertensive patients were included. Compared with ARBs or CCBs, sacubitril/valsartan significantly reduced 24-hour systolic variability (24hSBPV) and 24-hour diastolic blood pressure variability (24hDBPV), as well as 24-hour, daytime, and nighttime ambulatory blood pressure. It also improved the dipper blood pressure proportion and blood pressure control rate. Subgroup analysis showed that both 200 mg/d and 400 mg/d dosages achieved superior antihypertensive efficacy. In terms of safety, sacubitril/valsartan had a similar adverse event profile to CCBs. Compared with ARBs, sacubitril/valsartan at 200 mg/d was associated with a lower incidence of serious adverse events (SAE), and the overall rate of liver function abnormalities was also reduced. Sensitivity analyses confirmed robust results with no significant publication bias. In conclusion, sacubitril/valsartan effectively improves multiple ambulatory blood pressure parameters with a favorable safety profile, supporting its rational use in hypertensive patients.