Angiotensin receptor neprilysin inhibitor as a novel antihypertensive drug: Evidence from Asia and around the globe

Abstract

Hypertension is a worldwide epidemic that continues to grow, with a subset of patients responding poorly to current treatment available. This is especially relevant in Asia, which constitutes 61% of the global population. Hypertension in Asia is a unique entity that is often salt-sensitive, nocturnal, and systolic predominant. Sacubitril/valsartan is a first-in-class angiotensin receptor neprilysin inhibitor that was first used in heart failure with reduced ejection fraction. Sacubitril inhibits neprilysin, a metallopeptidase that degrades natriuretic peptides (NPs). NPs exert sympatholytic, diuretic, natriuretic, vasodilatory, and insulin-sensitizing effects mostly via cyclic guanosine monophosphate (cGMP)-mediated pathways. As an antihypertensive agent, sacubitril/valsartan has outperformed angiotensin II receptor type 1 blockers (ARBs), This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

The Application of Angiotensin Receptor Neprilysin Inhibitor in Cardiovascular Diseases: A Bibliometric Review From 2000 to 2022

“…In recent years, due to the emergence of some important new evidence-based medicine for heart failure drugs, the 2021 ESC guidelines ( 47 ) have been updated in this regard, and the status of ARNI has been importantly elevated to become the first-line drug for heart failure treatment, which brings hope for the treatment of heart failure patients. Not only that, several clinical studies in recent years have found that ARNI, represented by sacubitril valsartan, has good therapeutic effects in lowering blood pressure as a new generation drug, and its mechanism of action mainly includes diuretic, natriuretic, vasodilator and anti-sympathetic activity ( 48 – 53 ). Based on this, the 2020 International Society of Hypertension (ISH) Global Hypertension Practice Guidelines first recommended it as the preferred antihypertensive treatment for heart failure patients, bringing new hope for the treatment of hypertensive patients.…”

Seven‐action approaches for the management of hypertension in Asia – The HOPE Asia network

“…[86][87][88][89] Other sodium-excerting drugs such as angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, both of which are proven therapies for heart failure, are also effective in lowering BP. [90][91][92][93][94][95][96][97] SGLT2 inhibitors also decrease 24-hour BP in patients who have both diabetes and hypertension. [98][99][100][101] ARNI have recently been launched for the treatment of hypertension in Japan and China.…”

“…Mineralocorticoid receptor (MR) blockers reduce potassium excrete and hence increase serum potassium, and the recently developed selective MR blocker, esaxerenone, has been shown to reduce nighttime and morning BP, and decrease levels of N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) 86–89 . Other sodium‐excerting drugs such as angiotensin receptor‐neprilysin inhibitors (ARNI) and sodium‐glucose co‐transporter 2 (SGLT2) inhibitors, both of which are proven therapies for heart failure, are also effective in lowering BP 90–97 . SGLT2 inhibitors also decrease 24‐hour BP in patients who have both diabetes and hypertension 98–101 …”

Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments

“…79 Accumulating clinical evidence suggests that elderly patients with salt-sensitive hypertension/increased arterial stiffness who are at high risk for developing HF would be ideal candidates for treatment with sacubitril/ valsartan. 77,78,[80][81][82]…”