Blood pressure-lowering efficacy of Sacubitril/Allisartan versus Olmesartan in Chinese hypertensive patients with a nondipping blood pressure pattern.

Background: Abnormal nocturnal blood pressure dipping profile is an important cardiovascular risk factor in patients with hypertension. This analysis aimed to investigate the effects of Sacubitril/Allisartan on blood pressure in Chinese patients with mild to moderate hypertension and a nighttime nondipping pattern.

Methods: We performed analysis of data from a randomized clinical trial that compared the blood pressure-lowering effect at 12 weeks of treatment with Sacubitril/Allisartan (240 or 480 mg/day) and Olmesartan (20 mg/day). Nighttime nondipping pattern was defined as mean nighttime (10 p.m. to 6 a.m.) ambulatory blood pressure fall of less than 10% versus daytime (6 a.m. to 10 p.m.) ambulatory blood pressure. The outcome measures included clinical and 24-h, daytime, and nighttime ambulatory blood pressure.

Results: Of the 1197 randomized patients of the trial, 497 (41.5%) patients had a nighttime nondipping pattern and were included in this analysis. At 12 weeks, the least square mean (±standard error) changes from baseline in 24-h mean ambulatory SBP/DBP (maSBP/maDBP) in the Sacubitril/Allisartan 240 and 480 mg/day groups were -10.3 ± 1.1/-5.3 ± 0.6 and -13.7 ± 1.1/-6.7 ± 0.6 mmHg, respectively. The reductions in nighttime maSBP were significantly greater with both doses of Sacubitril/Allisartan compared with Olmesartan 20 mg [-12.7 ± 1.2/6.3 ± 0.7 mmHg, with a difference of -3.8 (-7.2 to -0.4) mmHg, P = 0.029 for Sacubitril/Allisartan 240 mg and -7.5 (-10.9 to -4.1) mmHg, P < 0.001 for Sacubitril/Allisartan 480 mg]. The 24-h mean ambulatory blood pressure and nighttime maSBP reductions in nondipper patients tended to be dose-dependent for Sacubitril/Allisartan. At 12 weeks of treatment, the prevalence of dippers was significantly (P ≤ 0.019) higher in the Sacubitril/Allisartan 240 and 480 mg groups than in the Olmesartan 20 mg group for both SBP (46.9 and 47.9 versus 33.7%) and DBP (42.0 and 40.2 versus 26.5%).

Conclusion: Sacubitril/Allisartan is particularly effective in reducing nighttime blood pressure and in reversing the nondipping to dipping nighttime blood pressure pattern.