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.
Xueyi Li, Lige Gao, Wenqing Guo et al.
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In 30 seconds
This meta-analysis of randomized controlled trials assessed sacubitril/valsartan versus angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs) in people with hypertension. Fifteen studies involving 4824 patients were included. Compared with these active treatments, sacubitril/valsartan improved 24-hour, daytime, and nighttime ambulatory blood pressure, reduced 24-hour systolic and diastolic blood pressure variability, and increased the proportions with a dipper pattern and blood pressure control. Its adverse-event profile was similar to CCBs; versus ARBs, the 200 mg/d dose was associated with fewer serious adverse events and liver function abnormalities.
Key findings
- Sacubitril/valsartan reduced 24-hour systolic and diastolic blood pressure variability compared with ARBs or CCBs.
- It lowered 24-hour, daytime, and nighttime ambulatory blood pressure and improved dipper proportion and blood pressure control.
- Both 200 and 400 mg/d doses showed superior antihypertensive efficacy in subgroup analyses.
- Adverse events were similar to CCBs; versus ARBs, 200 mg/d was associated with fewer serious adverse events, and liver function abnormalities were reduced overall.
Why it matters
Ambulatory blood pressure and its variability provide information beyond a single clinic measurement. These pooled trial findings suggest sacubitril/valsartan can improve several ambulatory blood pressure measures compared with two commonly used antihypertensive drug classes, while showing a broadly favorable safety profile. The results may inform evaluation of this option in hypertension, although the abstract does not provide effect sizes to judge the magnitude of benefit.
What to keep in mind
The abstract does not report pooled effect sizes or confidence intervals, limiting assessment of the magnitude and precision of the reported differences.