OBJECTIVES

Hypertension is a major public health problem globally, yet it remains inadequately controlled. As a first‐in‐class angiotensin receptor neprilysin inhibitor (ARNI), sacubitril/valsartan demonstrated potent blood pressure (BP) reduction in clinical trials. The objective is to assess the relative effect of sacubitril/valsartan and valsartan on BP in hypertensive patients.

METHODS

A systematic review and Bayesian network meta-analysis (NMA) of randomized controlled trials comparing sacubitril/valsartan 200mg and valsartan 160mg in adult hypertensive patients were conducted. The outcomes included change in office/clinic BP, change in 24-hour ambulatory BP and overall BP control rate. Embase, Medline and Cochrane library were searched. Fixed effects and random effects models were all applied.

RESULTS

Twelve studies with 5771 patients were included to constitute the network diagram consisting of sacubitril/valsartan , valsartan and placebo. For change in office/clinic BP at 8 weeks, mean difference (95% credible intervals) of sacubitril/valsartan 200mg compared with valsartan 160mg in systolic BP (SBP) and diastolic BP (DBP) were -4.59(-6.60,-2.59) and -2.28(-3.51,-1.05) respectively. For change in 24-hour ambulatory BP at 8 weeks, mean difference (95% credible intervals) of sacubitril/valsartan 200mg compared with valsartan 160mg in ambulatory SBP and ambulatory DBP were -4.95(-9.75,-0.04) and -1.42(-5.05,2.16) respectively. For overall BP control rate at 8 weeks, sacubitril/valsartan 200mg was associated with significantly higher BP control rate (risk ratio[RR],1.44 ; 95%CI, 1.10-1.96) compared with valsartan 160mg.

CONCLUSIONS

Sacubitril/valsartan 200mg is significantly superior to valsartan 160mg in reducing SBP, DBP and 24-hour ambulatory SBP, and shows greater BP control.