Comparison of the effects of angiotensin receptor–neprilysin inhibitors and thiazide diuretic/renin–angiotensin system inhibitor combination therapy in hypertensive patients: a retrospective cohort study

Clinical Benefit of Sacubitril/Valsartan for Hypertensive Patients in Daily Practice and Predictors of Its Antihypertensive Effect

“…In Japan, Sac/Val is currently used not only as a therapeutic agent for heart failure, 4 , 5 but also as an antihypertensive drug. 6 – 8 In particular, the BP-lowering effect of sacubitril through its neprilysin-inhibitory action is unique and not found in any other antihypertensive drug to date. 1 – 3 Most studies of the antihypertensive effect of Sac/Val have compared it with the antihypertensive effect of ARBs 9 – 13 or only examined the effects of switching from ARBs.…”

“…1 – 3 Most studies of the antihypertensive effect of Sac/Val have compared it with the antihypertensive effect of ARBs 9 – 13 or only examined the effects of switching from ARBs. 8 , 16 , 17 In the real-world clinical setting, however, Sac/Val is used not only for switching from ARBs, but also for switching from other classes/patterns of antihypertensive drugs, and as an additional drug for patients whose BP is not adequately controlled. In the present study, we clearly showed that the addition of Sac/Val in switching from or adding to various antihypertensive drugs was useful for additional BP-lowering in poorly controlled or untreated hypertensive patients.…”

“…Our findings on metabolic factors and renal function were generally consistent with those in a recent study comparing the effects of ARNI (Sac/Val) therapy and thiazide diuretic/renin–angiotensin system inhibitor combination therapy. 8 Therefore, switching to Sac/Val from antihypertensive agents such as ARB plus diuretic is likely to have favorable effects on metabolic factors and renal function, even if the BP reduction after drug switching remains minimal.…”

“…Sacubitril/valsartan (Sac/Val), a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that provides simultaneous neutral endopeptidase (neprilysin) inhibition and angiotensin II receptor-1 blockade, 1 – 3 has been currently approved in Japan not only for the treatment of chronic heart failure, 4 , 5 but also as an antihypertensive drug. 6 – 8 Many studies have shown that the antihypertensive effect of Sac/Val is greater than that of angiotensin II receptor blockers (ARBs), 9 – 13 which is probably derived from the natriuretic/diuretic and direct vasodilatory effects of sacubitril enhancing the biological activity of natriuretic peptides. 1 , 2 In real-world clinical practice of hypertension management, Sac/Val is used not only for switching from ARBs, but also for switching from other classes of antihypertensive drugs, including combination drugs, and as an additional drug for patients whose blood pressure (BP) is not adequately controlled.…”