Treatment with Sacubitril/Valsartan Effectively Manages Hypertension and Ameliorates Left Ventricular Hypertrophy in Hemodialysis Patients

Abstract

Introduction The present study aimed at investigating the efficacy of sacubitril/valsartan on hypertension management and cardiac remodeling in hemodialysis patients. Methods Hemodialysis patients with stable blood pressure control were enrolled in the study. Sacubitril/valsartan was prescribed to replace previously used ACEI/ARB or other antihypertensive drugs. During a 6-month follow-up period, pre-dialysis blood pressure, routine biochemical markers and N-terminal pro-brain natriuretic peptide levels were measured. Volume status was assessed using bioelectrical impedance analysis. Endothelial damage was evaluated by measuring asymmetric dimethylarginine expression, while echocardiography and life quality assessed by short-form 12 were conducted at baseline and after treatment. Results The median daily dose of sacubitril/valsartan in 32 participants was 200 mg, and no obvious adverse reactions were reported. The defined daily dose of other antihypertensive drugs (baseline 2.00±1.18, end point 1.46±1.30, t=3.216, P=0.003) reduced significantly. After treatment with sacubitril/valsartan, left ventricular ejection fraction significantly increased from 64.81±8.16% to 67.55±5.85% (t=-4.022, P≤0.001) and the thickness of posterior wall of the left ventricle reduced from 1.05±0.14 cm to 1.00±0.11 cm (t=2.063, P=0.048). The inter-ventricular septal thickness (baseline 1.08±0.16 cm, endpoint 1.02±0.12 cm, t=2.260, P=0.031) remarkably reduced by the end of follow-up. The tricuspid regurgitation pressure gradient decreased from 28.47±8.26 mmHg at baseline to 23.79±6.61 mmHg (t=2.531, P=0.020) after treatment. Conclusion Sacubitril/valsartan effectively manages hypertension in hemodialysis patients and may also independently improve left ventricular hypertrophy and systolic function, regardless of changes in the blood pressure or the volume load.