Malik Aaqib H, Aronow Wilbert S
Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.
Am J Ther. 2022;29(3):e322-e333. doi: 10.1097/MJT.0000000000000925.
Sacubitril/valsartan (LCZ696) has progressed to be one of the most promising medication since its approval for chronic heart failure with reduced ejection fraction. Recent data have suggested a superior blood pressure control with LCZ696.
What is the antihypertensive efficacy and safety profile of sacubitril/valsartan?
Randomized controlled trials (RCTs) comparing the efficacy and safety of LCZ696 against a placebo or angiotensin receptor blocker (ARB). RCTs were identified from a comprehensive search in PubMed, Embase, Cochrane library, and clinicaltrials.gov.
We used a change in systolic and diastolic blood pressures, both sitting as well as ambulatory, to calculate relevant effect sizes with their standard errors from the available change in mean and SD data. In addition, we also collected categorical data for the reported adverse effects from these trials. We performed a series of pairwise meta-analyses between LCZ696 versus an active comparator or a placebo.
Eleven RCTs with a total of 6028 participants had the relevant data available. Our meta-analysis showed that LCZ696 is an effective and a safe treatment for hypertension. It outperformed ARBs in every category, and the results are consistent across the different dosages of LCZ696. Compared with ARBs, 200 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure (DBP) by 4.62 mm Hg (95% confidence interval, 3.33-5.90, P < 0.001) and 2.13 mm Hg (95% confidence interval, 1.69-2.57, P < 0.001), respectively. Similarly, 400 mg of LCZ696 reduced systolic blood pressure and diastolic blood pressure by 5.50 mm Hg (2.94-8.07, P < 0.001) and 2.51 mm Hg (1.80-3.21, P < 0.001), respectively, in comparison with ARBs. The adverse effects with LCZ696 were not significantly higher compared with ARBs or placebo.
Sacubitril/valsartan is more effective for the management of hypertensive patients, compared with an ARB. Long-term prospective studies are required to identify whether this result translates into morbidity and mortality benefits.
沙库巴曲缬沙坦（LCZ696）自被批准用于射血分数降低的慢性心力衰竭以来，已发展成为最有前景的药物之一。近期数据表明，LCZ696在血压控制方面更具优势。
沙库巴曲缬沙坦的降压疗效和安全性如何？
比较LCZ696与安慰剂或血管紧张素受体阻滞剂（ARB）疗效和安全性的随机对照试验（RCT）。通过全面检索PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov识别RCT。
我们利用坐位及动态收缩压和舒张压的变化，根据均值和标准差的可用变化计算相关效应量及其标准误。此外，我们还收集了这些试验中报告的不良反应的分类数据。我们对LCZ696与活性对照药或安慰剂进行了一系列成对荟萃分析。
11项RCT共6028名参与者有可用的相关数据。我们的荟萃分析表明，LCZ696是一种有效且安全的高血压治疗药物。在各个类别中，它均优于ARB，且在不同剂量的LCZ696中结果一致。与ARB相比，200mg LCZ696可使收缩压和舒张压分别降低4.62mmHg（95%置信区间，3.3～5.90，P<0.001）和2.13mmHg（95%置信区间，1.69～2.57，P<0.001）。同样，与ARB相比，400mg LCZ696可使收缩压和舒张压分别降低5.50mmHg（2.94～8.07，P<0.001）和2.51mmHg（1.80～3.21，P<0.001）。LCZ696的不良反应与ARB或安慰剂相比无显著增加。
与ARB相比，沙库巴曲缬沙坦在高血压患者管理中更有效。需要进行长期前瞻性研究以确定这一结果是否能转化为发病率和死亡率的益处。
