Blood pressure lowering efficacy of sacubitril/allisartan versus olmesartan in elderly Chinese hypertensive patients.

BACKGROUND: Sacubitril/Allisartan, a novel angiotensin receptor-neprilysin inhibitor, has demonstrated antihypertensive efficacy in patients with hypertension. Its effects in the elderly patients, who often present with increased arterial stiffness and comorbidities, remain less understood. 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 mg/d or 480 mg/d) and olmesartan (20 mg/d). Eligible patients with mild-to-moderate hypertension and aged 65-75 years were included in the analysis. The primary outcome was change in clinic and 24-hour ambulatory blood pressure from baseline to week 12. RESULTS: Of the 1197 randomized patients, 338 elderly patients (41.5%) (mean age: 67.9 ± 2.3 years, 49.9% male) were included in this analysis. Baseline characteristics were comparable among treatment groups. At 12 weeks, least square mean (± standard error) changes from baseline in clinic systolic/diastolic blood pressure in the sacubitril/allisartan (240 mg/d or 480 mg/d) group and the olmesartan (20 mg/d) group were -24.0 ± 1.6/-5.7 ± 0.9 mmHg, -26.2 ± 1.6/-6.5 ± 0.9 mmHg, and -21.5 ± 1.6/-6.3 ± 0.9 mmHg, respectively. Greater reductions were also observed with sacubitril/allisartan (480 mg) compared with olmesartan (20 mg) in 24-hour, daytime and nighttime systolic blood pressure (all P-values < 0.05). The reductions in ambulatory blood pressure were dose-dependent (P = 0.007), and significantly greater with sacubitril/allisartan (480 mg) compared with olmesartan (20 mg) for nighttime blood pressure [-17.5 ± 1.8/-8.1 ± 1.0 mmHg, with a difference of -10.9 mmHg (-16.1 to -5.8, P < 0.0001) for systolic blood pressure and -4.5 mmHg (-7.3 to -1.8, P = 0.002) for diastolic blood pressure]. CONCLUSIONS: In elderly patients with hypertension, sacubitril/allisartan provided dose-dependent greater blood pressure reductions compared with olmesartan.