34. Efficacy and Safety of Sacubitril Valsartan in Managing Hypertension Compared with Angiotensin Receptor Blockers: A Systematic Review and Meta-analysis

Abstract

Background: Sacubitril/Valsartan has shown promising result in the management of heart failure with reduced ejection fraction patients. However, it also withhold the potential as antihypertensive agent. Thus, its effectiveness in reducing high blood pressure (BP) compared with Angiotensin Receptor Blockers (ARBs) needs to be determined. Objective: This study aimed to compare the efficacy and safety of Sacubitril/Valsartan and ARBs in managing hypertension patients. Methods: We searched for the studies from Pubmed, Proquest, Google Scholar and Cochrane Library databases which compare the BP reduction effect of Sacubitril/Valsartan and ARBs. The main outcomes were mean office and ambulatory BP reduction. The safety profile was determined by the incidence of adverse events (AEs). Results: 5114 adult patients with hypertension from 10 RCTs were included. Sacubitril/Valsartan provided significant mean reduction of office systolic BP (mean difference: –4.66; 95%CI: –5.13 to –4.20; p < 0.001), office diastolic BP (mean difference: –3.23; 95%CI: –3.54 to –2.92; p < 0.001), ambulatory systolic BP (mean difference: –3.42; 95%CI: –5.13 to –1.17; p < 0.001), and ambulatory diastolic BP compared with ARBs (mean difference: –1.50; 95%CI: –2.15 to –0.85; p < 0.001). There was no significant difference in the incidence of AEs between the two groups (RR: 1.04; 95%CI: 0.95 to 1.14; p = 0.35). The BP reduction and incidence of AEs were consistent in the subgroup analysis (Olmesartan and Valsartan treatment group), except in comparison with Olmesartan treatment group for ambulatory systolic BP parameter (mean difference: –2.62; 95% CI: –5.30 to 0.07; p: 0.06). Conclusion: Sacubitril/Valsartan is more potent in reducing BP to ARBs, with similar safety profile.