Greater reduction of LV mass index with ARNI than with ARB in hypertensive patientsLiterature - Schmieder RE, Wagner F, Mayr M, et al. - Eur Heart J 2017; published online ahead of print
- SBP was decreased in the sacubitril/valsartan group compared to the olmesartan group after 52 weeks of treatment (26.1 mmHg vs 20.8 mmHg, respectively, 95%CI:-9.46 to -0.53, P=0.028], whereas no difference in SBP was observed between the two groups after 12 weeks, nor for levels of DBP after both 12 and 52 weeks.
- No treatment differences were observed for changes from baseline to 12 and 52 weeks in local distensibility of ascending aorta, proximal descending aorta, or distal descending aorta.
- LV mass was decreased in both groups, but a greater reduction was observed in the sacubitril/valsartan group than in the olmesartan group with a treatment difference of 8.0966 g (95% CI:-15.9848 to -0.2084, P=0.049) after 12 weeks and -5.1942 g (95%CI: -10.65 to 0.26, P=0.062) after 52 weeks.
- A greater reduction was observed when LV mass was adjusted for body surface area (LV mass index) in the sacubitril/valsartan group than in the olmesartan group; the treatment difference was -4.05 g/m2 (95% CI: -7.90 to -0.20, P=0.039] from baseline to 12 weeks and -3.27 g/m2 (95% CI: -6.21 to -0.34), P= 0.029) to 52 weeks.
- Adjusting for the changes in SBP at 12 and 52 weeks resulted in treatment differences of LV mass index of -3.57 g/m2 (95% CI: -7.32 to 0.18, P=0.0619) and -2.80 g/m2 (95% CI: -5.63 to 0.04, P=0.0529), respectively, with a greater, but non-significant reduction in the sacubitril/valsartan group than the olmesartan group.
- Central PP was significantly more decreased in the sacubitril/valsartan group compared to the olmesartan group after 52 weeks with a mean difference of -3.50 mmHg (95% CI: -6.15 to -0.85, P=0.010).
In patients with hypertension, treatment with sacubitril/valsartan was associated with superior reductions of LV mass after 12 and 52 weeks and central PP after 52 weeks compared to treatment with olmesartan, suggesting that sacubitril/valsartan may lead to a better cardiovascular prognosis in this patient population than olmesartan.