Role of Neprilysin Inhibitor Combinations in Hypertension
Role of Neprilysin Inhibitor Combinations in Hypertension
Both diabetes and chronic kidney disease are associated with high prevalence of hypertension. The efficacy of ARNI in this important patient groups remains to be evaluated since in both the hypertension trials, patients with Type 1 and 2 diabetes and renal disease were excluded. Kario et al. found a negligible change in serum creatinine in placebo and LCZ696 groups. The mean change in serum creatinine from baseline was 0.02 mg/dL in the placebo group and 0.01 and 0.03 mg/dL in LCZ696 200 and 400 mg, respectively. In the PARAMOUNT trial involving patients with HFpEF, treatment with LCZ696 for 36 weeks resulted in lower serum creatinine and higher estimated glomerular filtration rate (eGFR) compared with valsartan. The mean serum creatinine increase was 0.03 mg/dL in LCZ696 group and 0.09 mg/dL in the valsartan group (P = 0.007). Accordingly, the decline in eGFR was lower in the LCZ696 group than in the valsartan group (−1.5 vs. −5.2 mL/min per 1.73 m; P = 0.002). Moreover, in a recent meta-analysis, both omapatrilat and LCZ696 demonstrated a favourable effect on renal function compared with ACE-inhibitors or ARB monotherapy in patients with heart failure. It remains to be seen whether similar nephro-protective effect of LCZ696 can be found in patients with hypertension.
Angiotensin II-Receptor and Neprilysin Inhibitor in Hypertension and Specific Comorbidities
Both diabetes and chronic kidney disease are associated with high prevalence of hypertension. The efficacy of ARNI in this important patient groups remains to be evaluated since in both the hypertension trials, patients with Type 1 and 2 diabetes and renal disease were excluded. Kario et al. found a negligible change in serum creatinine in placebo and LCZ696 groups. The mean change in serum creatinine from baseline was 0.02 mg/dL in the placebo group and 0.01 and 0.03 mg/dL in LCZ696 200 and 400 mg, respectively. In the PARAMOUNT trial involving patients with HFpEF, treatment with LCZ696 for 36 weeks resulted in lower serum creatinine and higher estimated glomerular filtration rate (eGFR) compared with valsartan. The mean serum creatinine increase was 0.03 mg/dL in LCZ696 group and 0.09 mg/dL in the valsartan group (P = 0.007). Accordingly, the decline in eGFR was lower in the LCZ696 group than in the valsartan group (−1.5 vs. −5.2 mL/min per 1.73 m; P = 0.002). Moreover, in a recent meta-analysis, both omapatrilat and LCZ696 demonstrated a favourable effect on renal function compared with ACE-inhibitors or ARB monotherapy in patients with heart failure. It remains to be seen whether similar nephro-protective effect of LCZ696 can be found in patients with hypertension.
