BLOOD PRESSURE LOWERING EFFICACY OF SACUBITRIL/ALLISARTAN VERSUS OLMESARTAN IN CHINESE HYPERTENSIVE PATIENTS WITH A NON-DIPPING BLOOD PRESSURE PATTERN

Objective: 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 non-dipping pattern. Design and method: 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/d) and Olmesartan (20 mg/d). Nighttime non-dipping pattern was defined as mean nighttime (10 pm-6 am) ambulatory blood pressure fall of <10% versus daytime (6 am-10 pm) ambulatory blood pressure. The outcome measures included clinical and 24-hour, daytime, and nighttime ambulatory blood pressure. Results: Of the 1197 randomized patients of the trial, 497 (41.5%) patients had a nighttime non-dipping pattern and were included in this analysis. The least square mean (±standard error) changes from baseline in 24 h mean ambulatory systolic/diastolic blood pressure (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 non-dipper patients tended to be dose-dependent for Sacubitril/Allisartan. At 12 weeks of treatment, the prevalence of dippers was higher in the Sacubitril/Allisartan 240 and 480 mg groups than in the Olmesartan 20 mg group for both systolic (46.9% and 47.9% vs 33.7%) and diastolic blood pressure (42.0% and 40.2% vs 26.5%), being statistically significant for the 480 mg group (P=0.011, 0.008, and 0.002 respectively). Conclusions: Sacubitril/Allisartan is particularly effective in reducing nighttime blood pressure and in reversing the non-dipping to dipping nighttime blood pressure pattern.