Sacubitril/Valsartan More Efficacious for Controlling Blood Pressure vs Olmesartan

Controlling blood pressure in patients with hypertension is safer and more efficacious with sacubitril/valsartan vs olmesartan, according to findings published in the American Journal of Hypertension.

Previous comparisons of sacubitril/valsartan and olmesartan for the treatment of hypertension produced inconsistent results regarding effectiveness, which led investigators of the current study to compare the efficacy and safety of sacubitril/valsartan and olmesartan for the treatment of hypertension.

The investigators systematically searched the Cochrane Library, Embase, Web of Science, ClinicalTrials.gov, and PubMed databases through mid-November 2022 for randomized controlled trials, in which sacubitril/valsartan was administered to the experimental group and olmesartan administered to the control group to study their effects on blood pressure control, with recognized statistical significance with P values less than 0.05.

The review authors included 6 studies (N=4127 patients) among whom 2497 patients were treated with sacubitril/valsartan (83.8% Asian patients) and 1630 patients were treated with olmesartan (76.5% Asian patients). Included studies were all judged as high-quality by the Cochrane Collaboration tool for risk of bias, and the Egger test showed no significant publication bias.

The investigators found that sacubitril/valsartan vs olmesartan significantly decreased mean sitting systolic and diastolic blood pressure and sitting pulse pressure, as well as 24-hour ambulatory systolic and diastolic blood pressure. For different doses of sacubitril/valsartan, analysis of the antihypertensive effects showed mean ambulatory systolic blood pressure (maSBP) and mean ambulatory diastolic blood pressure were significantly reduced with sacubitril/valsartan 200 mg/d and 400 mg/d, although heterogeneity was very high among the studies showing maSBP.

Occurrence of the majority of adverse events (including nausea, back pain, abdominal pain, respiratory tract infection, and dizziness) showed no significant difference between sacubitril/valsartan and olmesartan. A decreased probability of headache was noted in patients treated with sacubitril/valsartan. Serious adverse events (including stroke, intracranial hemorrhage, coronary disease, and arrhythmia) were more effectively reduced with sacubitril/valsartan 400 mg/d than with olmesartan according to subgroup analysis.

Sensitivity analysis (using 1-by-1 elimination) showed no significant changes in the outcome indicators with relatively low heterogeneity.

Limitations of the study include the underpowered sample size for the verification of therapeutic effects comparison at different doses, the long-term antihypertensive effect of sacubitril/valsartan is not explained, and the inability to determine long-term side effects.

“Sacubitril/valsartan was better than olmesartan in controlling blood pressure in patients with hypertension, with relatively higher safety,” the investigators wrote. “The antihypertensive effect of LCZ696 [sacubitril/valsartan] was greater than that of olmesartan. According to the subgroup analysis, the antihypertensive effect of LCZ696 was directly related to the dose.”