Dose‑dependent Reduction of Blood Pressure by Angiotensin Receptor‑neprilysin Inhibitor: A Network Meta‑analysis
Context:
Angiotensin receptor-neprilysin inhibitor (ARNi) has been established as the standard medication for heart failure. However, the blood pressure (BP)-lowering effect circumvented its administration and titration in patients with borderline hypotension.
This study aimed to determine the correlation between ARNi dosage and hemodynamic impacts. Subjects and
A network meta-analysis was conducted to interrogate the BP impact of ARNi (sacubitril/valsartan 100 mg/d, 200 mg/d, 400 mg/d) and angiotensin receptor blocker (ARB) counterparts. Individuals with mild-to-moderate systolic hypertension were enrolled in respective studies. The outcomes were set as the change from baseline systolic and diastolic BP. Statistical Analysis Used: Network meta-analysis, node-splitting, and inconsistency model methods in Bayesian approach were employed.
A total of 14 manuscripts with 7705 subjects were included for pooled analysis. Compared with ARB, sacubitril/valsartan 400 mg/d and 200 mg/d, but not 100 mg/d, were associated with significantly greater reduction effect of systolic and diastolic BP, either by office documentation or 24-h ambulatory monitoring. The BP-lowering effect of sacubitril/valsartan 400 mg/d and 200 mg/d was nevertheless equivalent.
ARNi exerts a dose-dependent effect on BP reduction. Such hemodynamic impact exceeds ARB at higher doses.
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