Physicians' Academy for Cardiovascular Education

Greater reduction of LV mass index with ARNI than with ARB in hypertensive patients

Schmieder RE, Wagner F, Mayr M, et al. - Eur Heart J 2017; published online ahead of print

Background

CV remodeling has been associated with increased CV risk, as demonstrated in community-based cohorts and patients with essential hypertension [1,2], and is therefore an important treatment target. The dual-action sacubitril/valsartan, a relatively new drug, inhibits neprilysin and disrupts angiotensin II signaling through blockade of the angiotensin receptor (ARB) [3,4]. This drug has been demonstrated to reduce the risk of the composite end point of CV death, heart failure hospitalization, CV death and death from any cause in patients with heart failure compared to the ACE-inhibitor enalapril [5].

The effects of sacubitril/valsartan on LV mass and large arteries compared to the ARB olmesartan were studied in a multi-center, randomized, double-blind, double-dummy, active-controlled, parallel group trial in patients with hypertension and elevated pulse pressure (PP). 114 patients were randomized in a 1:1 ratio to receive sacubitril/valsartan (n=57) or olmesartan (n=57) for 52 weeks.

Main results

Conclusion

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.

References

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Find this article online at Eur Heart J