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

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.

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.

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].

In elderly patients with hypertension, sacubitril/allisartan provided dose-dependent greater blood pressure reductions compared with olmesartan.