Effects of LCZ696 (Sacubitril/Valsartan) on Blood Pressure in Patients with Hypertension: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: LCZ696 (sacubitril/valsartan), a first-in-class angiotensin receptor-neprilysin inhibitor, can significantly reduce blood pressure in patients with heart failure. We performed this meta-analysis to determine the antihypertensive effect of LCZ696 in patients with hypertension. Methods: Randomized controlled trials were searched in MEDLINE, the Cochrane Library, and Clinicaltrials.gov. Twelve studies with a total of 6,064 participants were included. Results: Compared with angiotensin receptor blockers (ARBs), LCZ696 100 mg caused a significant reduction in systolic blood pressure (SBP) (mean difference [MD] –1.58 mm Hg, 95% confidence interval [CI] –2.09 to –1.07, p < 0.05) and diastolic blood pressure (DBP) (MD –0.66 mm Hg, 95% CI –0.98 to –0.33, p < 0.05). LCZ696 200 mg caused a significant reduction in SBP (MD –4.94 mm Hg, 95% CI –6.54 to –3.35, p < 0.05), DBP (MD –2.24 mm Hg, 95% CI –2.74 to –1.75, p < 0.05), 24-h ambulatory SBP (24 h ASBP; MD –3.69 mm Hg, 95% CI –4.80 to –2.58, p < 0.05), and 24-h ADBP (MD –1.71 mm Hg, 95% CI –2.13 to –1.28, p < 0.05). LCZ696 400 mg caused a significant reduction in SBP (MD –6.25 mm Hg, 95% CI –7.90 to –4.61, p < 0.05), DBP (MD -2.30 mm Hg, 95% CI –2.80 to –1.80, p < 0.05), 24-h ASBP (MD –4.31 mm Hg, 95% CI –6.56 to –2.07, p < 0.05), and 24 h ADBP (MD –1.69 mm Hg, 95% CI –2.59 to –0.79, p < 0.05). Compared with LCZ696 200 mg, LCZ696 400 mg caused a significant reduction in SBP (MD 1.71 mm Hg, 95% CI 1.15 to 2.27, p < 0.05), DBP (MD 0.90 mm Hg, 95% CI 0.65 to 1.16, p < 0.05), 24-h ASBP (MD 1.50 mm Hg, 95% CI 0.84 to 2.17, p < 0.05), and 24-h ADBP (MD 0.76 mm Hg, 95% CI 0.47 to 1.06, p < 0.05). Conclusions: The blood pressure-lowering effect of LCZ696 is dose-related. This meta-analysis confirms the antihypertensive effects of LCZ696.