EFFECTS OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITOR (ARNI) ON HOME BLOOD PRESSURE AND BAPWV IN ESSENTIAL HYPERTENSIVE PATIENTS

Abstract

Objective: Sacubitril/valsartan sodium hydrate (Entresto) is classified as an ARNI and has a novel mechanism of action that simultaneously inhibits neprilysin and angiotensin II receptors. We investigated the effects of Entresto on blood pressure (BP), baPWV, and carotid arterial intima-media thickness (IMT) and elasticity in essential hypertension. Design and method: Fifty-two hypertensive patients (twenty-six males, average age 67 years) who had insufficient BP reduction (home systolic 135 or diastolic 85 mmHg or higher) after receiving ARBs (azilsartan 26 or valsartan 26) for more than 6 months, were assigned to receive Entresto for 12 months (200-400mg/day, gradually increase depending on the condition). Changes in home BP, biochemical data, baPWV, central blood pressure (cSBP) were evaluated. The carotid arterial IMT and elastic modulus in the circumferential direction (Eθ) were simultaneously measured by the high-resolution Doppler technique, “Phased Tracking Method”. Results: Home morning BP (mmHg) after administration of Entresto significantly (p<0.05) decreased from 142.9±11.3/80.0±12.1 to 125.7±7.4/70.9±12.0, and home heart rate (HR, bpm) also significantly decreased from 75.1±11.3 to 72.2±11.9. There were no differences in BP and HR changes between ARBs. Furthermore, baPWV (m/sec) significantly decreased from 1542.4±259.8 to 1438.4±222.41, and cSBP (mmHg) significantly decreased from 141.0±9.1 to 133.2±8.4. Urine protein (mg/g/Cr) decreased significantly from 319.6±473.6 to 213.1±376.4, but there were no significant changes in eGFR (45.6±14.1 to 44.5±14.5 mL/min/1.73m2) nor serum potassium (4.2±0.4 to 4.0±0.9mEq/L). Eθ (kPa) was reduced significantly from 301±141 to 163±41 without changes in IMT. The histogram analysis of the Eθ data revealed the drug decreased harder components of the elasticity distribution, suggesting improvement of endothelial dysfunction. Conclusions: These data demonstrate that the ARNI, Entresto provides potent antihypertensive and antiatherosclerotic effects.