Sacubitril/valsartan reversal of left ventricular remodeling is associated with improved hemodynamics in resistant hypertension

Background Sacubitril/valsartan (S/V) has been shown to be an effective antihypertensive drug combination. However, its therapeutic effects on blood pressure (BP) and hemodynamics as well as left ventricular (LV) remodeling in resistant hypertension (RHTN) remain unclear. Methods Eighty-six patients completed this self-control study, during which olmesartan was administered within the first 8 weeks (phase 1) followed by S/V within the second 8 weeks (phase 2), with nifedipine and hydrochlorothiazide taken as background medications. Office BP, echocardiography and hemodynamics assessment using impedance cardiography were performed at baseline, the eighth and sixteenth weeks. Results The reduction in office BP was larger in phase 2 than in phase 1 (19.59/11.66 mmHg vs. 2.88/1.15 mmHg). Besides, the treatment in phase 2 provided greater reductions in systemic vascular resistance index (SVRI) and thoracic blood saturation ratio (TBR), with differences between two phases of -226.59 (-1212.80 to 509.55) dyn·s/cm5/m2 and -0.02 (-0.04 to 0.02). Switching from olmesartan to S/V also significantly reduced E/E`, LV mass index, LV end-diastolic volume index and LV end-systolic volume index (all P < 0.05). Decreases in AS, SVRI and TBR were correlated with changes in indicators of LV remodeling (all P < 0.05). And the correlation still remained even after adjusting for confounders including changes in BP. Conclusions Switching from olmesartan to S/V effectively lowered BP and reversed ventricular remodeling in RHTN. In addition, hemodynamics improvement was also observed. Changes in hemodynamics played an important role in reversing LV remodeling of S/V, which were independent of its antihypertensive effect.