Physicians' Academy for Cardiovascular Education

Beneficial effects of antihypertensive therapy on central hemodynamics

Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension. The PARAMETER Study

Williams B, Cockcroft JR, Kario K, et al. - Hypertension. 2017;69: published online ahead of print


Systolic hypertension and increased pulse pressure (PP) are indicative of arterial ageing and stiffening, and predict incident cardiovascular disease, stroke, chronic kidney disease, and heart failure [1,2]. Moreover, arterial stiffening causes elevations of the central aortic systolic pressure (CASP) and PP relative to brachial pressures, leading to reduced aortic:brachial pressure pulse amplification [3]. While antihypertensive therapies in elderly patients reduce systolic blood pressure (SBP), cardiovascular morbidity and mortality, they have differential effects on central aortic pressures, despite the similar effects on brachial blood pressure [4,5].

In this study, the short- and long-term effects at 12 and 52 weeks of sacubitril/valsartan in comparison with olmesartan were assessed on CASP and other measures of central hemodynamics and arterial stiffness. This was measured in 367 elderly patients with elevated SBP and increased PP.

Main results


In elderly patients with elevated SBP and PP, sacubitril/valsartan was superior compared with olmesartan in reducing sitting and ambulatory central aortic and brachial pressures. The greater reduction in NT-proBNP and PP observed with sacubitril/valsartan indicates a de-stiffening effect of sacubitril/valsartan and a reduction in cardiac wall stress. These findings suggest that sacubitril/valsartan provides beneficial effects on central aortic hemodynamics.


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