Sacubitril-valsartan a boon to hypertension patients with ESKD on dialysis

Treatment with sacubitril-valsartan (SV) demonstrates good tolerability and may provide some benefits to hypertension patients with end-stage kidney disease (ESKD) who are undergoing dialysis, as shown by the results of a recent meta-analysis.

A team of investigators searched the databases of Medline, Cochrane, Embase, Web of Science, and ClinicalTrials.gov for studies reporting outcomes after SV treatment. Random effect models were used to carry out analyses.

Nineteen studies met the eligibility criteria and involved a total of 1,597 patients with both hypertension and ESKD while on dialysis.

SV treatment resulted in significant reductions in both systolic (SBP) and diastolic (DBP) blood pressure (BP; mean change in SBP, –11.09 mm Hg, 95 percent confidence interval [CI], –14.51 to –7.66; mean change in DBP, –4.37 mm Hg, 95 percent CI, –6.36 to –2.38). 

Patients treated with SV also had a lower risk of cardiovascular hospitalization (risk ratio [RR], 0.63, 95 percent CI, 0.44–0.90) than those who received conventional treatment. In addition, SV treatment appeared to have protective effects against all-cause mortality, albeit statistically nonsignificant (RR, 0.66, 95 percent CI, 0.27–1.60).

When evaluating the echocardiographic parameters in studies including hypertension patients with heart failure (HF), the investigators noted an improvement in left ventricular ejection fraction (LVEF; mean change 7.04), but this effect was more noticeable among those with HF with reduced ejection fraction (p=0.0003 for interaction).

Furthermore, SV treatment led to reductions in LV systolic dysfunction, LV diastolic dysfunction, left anterior descending artery, and E/e’ ratio (p<0.05).

On the other hand, the risks of severe hyperkalemia and symptomatic hypotension did not differ between SV treatment and conventional treatment (p>0.05).

“The present study revealed that sacubitril-valsartan treatment is well tolerated and could have potential benefits in hypertension patients with ESKD on dialysis by effectively controlling blood pressure, improving LVEF, reversing cardiac remodelling, and reducing the risk of cardiovascular hospitalization,” the investigators said.