Schmieder RE, et al. - An exploratory analysis was carried out of the effects of sacubitril/valsartan (LCZ696), a dual-action angiotensin receptor blocker (ARB), and neprilysin inhibitor, on the arterial stiffness and left ventricular (LV) remodelling. Owing to the connection between LV mass variation with cardiovascular prognosis, the greater reductions in LV mass yielded valuable advantages of sacubitril/valsartan compared to olmesartan. LV mass index decrease possibly appeared to be independent of systolic blood pressure (SBP) to a certain extent. This led to the belief that the upshot of the dual-acting agent could extend beyond those due to its blood pressure (BP)-lowering ability.

Methods

• The plot of this research was a randomized, multi-centre, double-blind, double-dummy, active-controlled, parallel group study.
• It comparatively analyzed the effects of sacubitril/valsartan on cardiovascular remodelling with those of olmesartan in patients with hypertension and elevated pulse pressure.
• Magnetic resonance imaging scans evaluated the LV mass and local aortic distensibility, at baseline and at 12 and 52 weeks after initiation of treatment.
• The SphymoCor XCEL device estimated the central pulse and systolic pressure, at each time point.

Results

• 114 patients were recruited, with 57 in each therapy group.
• The mean age was 59.8 years, and 67.5% were male.
• There was no variation in the demographic characteristics between the two sets of patients.
• Left ventricular mass index exhibited a significant decrease in the sacubitril/valsartan group than the olmesartan group from baseline to 12 weeks (-6.36 vs. -2.32 g/m²; P = 0.039) and from baseline to 52 weeks (-6.83 vs. -3.55 g/m²; P = 0.029).
• Such variations were prominently persisitent after adjustment for systolic blood pressure (SBP) at follow-up (P = 0.036 and 0.019 at 12 and 52 weeks, respectively), with similar signals (though formally non-significant) after adjusting for changes in SBP (P = 0.0612 and P = 0.0529, respectively).
• No notable changes appeared in the local distensibility variations from baseline to 12 or 52 weeks between the two groups.
• A larger reduction was brought to light in the central pulse pressure for the sacubitril/valsartan group compared to the olmesartan group (P = 0.010).