At the 2025 American Heart Association Scientific Sessions held in New Orleans in the US state of Lousiana from 7 to 10 November, investigators presented real-world results from a retrospective cohort study examining sacubitril/valsartan in 2,000 adults with resistant hypertension across sites in the US, the Middle East and Europe. The study tracked blood pressure control and adverse outcomes over one year in patients who initiated sacubitril/valsartan between 2016 and 2024.
Resistant hypertension is defined as blood pressure that remains above 140/90 mm Hg despite treatment with three or more antihypertensive medicines, typically including a diuretic. These patients remain at high risk for cardiovascular, kidney and metabolic complications, and often have few remaining medical options.
The investigation enrolled adults aged 18 or older diagnosed with resistant hypertension, newly started on sacubitril/valsartan. Patients were followed at four, eight, 24 and 52 weeks for changes in blood pressure, achievement of treatment targets and rates of adverse events, including acute kidney injury, major adverse cardiovascular events, mortality and hospitalisations.
Researchers found that the proportion of patients achieving target blood pressure (systolic blood pressure ≤130 mm Hg and diastolic blood pressure ≤80 mm Hg) steadily increased, reaching up to 77% at one year. However, significant and growing rates of adverse events — including acute kidney injury, electrolyte disturbances such as hypokalemia and hyponatremia, and all-cause hospitalisations — were observed over the same timeframe.
Key opinion leaders (KOLs) interviewed by GlobalData stated: “Close monitoring is critical, as not all patients will tolerate the risks.” KOLs also emphasised the need for more real-world insight to better understand which resistant hypertension patients derive the most benefit with manageable safety from sacubitril/valsartan.
These findings support sacubitril/valsartan's role as a potentially valuable late-line therapy for resistant hypertension, but underscore the need for careful patient selection and frequent monitoring. Competitive positioning may be enhanced by improved efficacy in a highly refractory population, yet broader uptake will likely hinge on finding the right balance between antihypertensive benefit and safety.
Looking forward, use of sacubitril/valsartan in resistant hypertension will depend on strategies that integrate close monitoring and multidisciplinary care, as well as future development of agents with more favourable safety profiles for this complex, high-risk patient group.
