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 StudyLiterature - Williams B, Cockcroft JR, Kario K, et al. - Hypertension. 2017;69: published online ahead of print
- The mean reductions in CASP after 12 weeks were −12.6 mmHg (95% CI: −14 to −10.1) with sacubitril/valsartan and −8.9 mmHg (95% CI: −11.1 to −6.7) with olmesartan.
- The least squares mean (LSM) reductions in CASP were superior with sacubitril/valsartan versus olmesartan with a between-treatment difference of −3.7 mmHg (95% CI: −6.4 to −0.9 mmHg; P=0.01).
- At 12 weeks, the LSM reductions in central aortic PP (CAPP) were superior with sacubitril/valsartan versus olmesartan with a between-treatment difference of −2.4 mmHg (P=0.01).
- Sacubitril/valsartan lowered mean sitting SBP and mean sitting PP to a greater extent than olmesartan at week 12 (between-treatment difference -3.8 and -2.8, respectively), but not central aortic diastolic pressure or mean sitting DBP.
- The LSM reductions in mean 24-hour ambulatory brachial and central aortic systolic pressures were significantly greater with sacubitril/valsartan versus olmesartan after 12 weeks, with a between-treatment difference of −4.1 mm Hg (P<0.001) for mean ambulatory SBP and −3.4 mmHg (P<0.001) for mean ambulatory CASP.
- Night-time reductions in mean ambulatory CASP (−5.2 mmHg) and mean ambulatory SBP (−5.9 mmHg) were significantly (P<0.001) greater with sacubitril/valsartan compared with olmesartan with the greatest differences in the early morning hours in mean ambulatory CASP (−6.3 mmHg) and mean ambulatory SBP (−6.9 mmHg).
- The requirement of an add-on antihypertensive therapy was significantly lower in patients treated with sacubitril/valsartan versus olmesartan (P<0.002) from weeks 12 to 52.
- The reduction in the geometric mean plasma NT-proBNP from baseline to week 12 was greater in patients treated with sacubitril/valsartan (34%) compared with olmesartan (20%), and this difference was attenuated by week 52.
- Treatments with both sacubitril/valsartan and olmesartan were generally well tolerated and adverse events were balanced between treatment groups.
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.