Effect And Safety Of Sacubitril/Valsartan In The Treatment Of Hypertension Compared With Angiotensin Ⅱ Receptor Blockers

Objective: Whether angiotensin receptor neprilysin inhibitor(ARNI)has greater advantages of blood pressure(BP)lowering than angiotensin II receptor blockers(ARB)is controversial.To provide more detailed information about the benefits of ARNI,we conducted a meta-analysis to evaluate the efficacy and safety of ARNI for short-term management of hypertension compared with ARB.Methods: We searched CNKI,Wanfang database,Pub Med,Embase,the Cochrane Library,and Clinical Trials to find randomized controlled trials(RCT)sacubitril/valsartan and ARB in the treatment of patients with hypertension up to June2020.Hypertensive patients were divided into experimental group and control group,and the experimental group received ARNI and the control group received ARB.The continuous variables were expressed as the weighted mean difference(WMD)and 95%confidence interval(CI)between the treatment group and the control group,and 95%CI Relative Risk(RR)or Odds Ratio(OR)was used as the effect size of the dichotomous variables.Results: In the present meta-analysis,8 studies were incorporated,including 6372 hypertensive patients.The meta-analysis of articles found: compared with ARBs,ARNI revealed significant reduction in mean sitting systolic BP(ms SBP;WMD-4.79 mm Hg;95% CI:-5.46 to-4.11 mm Hg),mean sitting diastolic BP(ms DBP;WMD-2.12 mm Hg;95% CI:-2.53 to-1.71 mm Hg),mean sitting pulse pressure(ms PP;WMD-2.79 mm Hg;95% CI:-3.52 to-2.07 mm Hg)and mean ambulatory pulse pressure(ma PP;WMD-2.96 mm Hg;95% CI:-3.35 to-2.57 mm Hg).ARNI had a higher BP control rate than ARB(OR = 1.55;95% CI:1.39 to 1.73).There was no significant difference between ARNI and ARB in the incidence of AE(RR = 1.10;95% CI: 0.96 to 1.25)and discontinuations because of AE(RR = 0.97;95% CI: 0.54 to 1.32).Conclusions: In short-term treatment,ARNI has greater advantages of antihypertensive efficacy and tolerated well.In the long-term treatment of hypertension,the efficacy and safety of ARNI are still unclear,and more evidence of evidencebased medicine is needed to prove whether ARNI affects the cognitive function of patients with hypertension.