Enhancing Home Blood Pressure Management: Implementation of the Sacubitril/Valsartan Treatment in Practical Clinical Settings.

Introduction: Although the importance of home blood pressure (BP) management has been widely reported, the achievement rate of home BP targets remains low in Japan. Sacubitril/valsartan is a novel antihypertensive agent with potent antihypertensive effects. Despite its theoretical advantages, the real-world clinical application of sacubitril/valsartan in optimizing home BP management remains underexplored. The aim of this study was to evaluate the effect of switching from azilsartan treatment to sacubitril/valsartan treatment on the achievement of home BP targets and to refine hypertension management strategies in practical clinical settings.

Methods: A cohort of 55 patients, with a mean morning home systolic BP of 135 mmHg or more was enrolled for an 8-week treatment phase with azilsartan and calcium-channel blockers. Morning BP, pulse rate (PR), estimated glomerular filtration rate, and B-type natriuretic peptide, serum potassium, serum uric acid (UA), and hemoglobin A1c levels were assessed at baseline and then at 8, 24, and 48 weeks after switching from 20 mg azilsartan to 200 mg sacubitril/valsartan.

Results: At 48 weeks after switching to sacubitril/valsartan, there was a 60% increase in the rate of attainment of home systolic BP targets. Sacubitril/valsartan significantly reduced the mean systolic BP (from 143.6 ± 7.0 mmHg to 131.4 ± 8.7 mmHg), diastolic BP (from 86.9 ± 12.3 mmHg to 80.2 ± 10.7 mmHg), PR (from 74.8 ± 11.0 bpm to 72.1 ± 10.1 bpm), and serum UA (from 5.9 ± 1.1 mg/dL to 5.5 ± 0.9 mg/dL) within the first 8 weeks (all p < 0.01). These effects were maintained for 48 weeks.

Conclusions: The switch from azilsartan to sacubitril/valsartan treatment resulted in a significant improvement in the achievement of home BP targets, which is consistent with our goal of refining hypertension management strategies in practical clinical settings.