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    Home > Active Ingredient News > Endocrine System > Shacubatril and Valsartan is officially approved for hypertension indication!

    Shacubatril and Valsartan is officially approved for hypertension indication!

    • Last Update: 2021-06-18
    • Source: Internet
    • Author: User
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    *It is only for medical professionals to read for reference.
    Unlike previous antihypertensive drugs, sacubitril and valsartan reduce blood pressure at the same time, break the chain of cardiovascular events through the dual effects of natriuretic peptide and RAAS, and provide multiple protections to target organs.
    It is more suitable for patients with diabetes and hypertension
    .

    On June 1, 2021, angiotensin receptor enkephalinase inhibitor (ARNI), which has already shined in the field of heart failure, was approved for hypertension indications, which is undoubtedly a major issue for patients with diabetes and hypertension.
    Great news! The coexistence rate of hypertension and diabetes is relatively high in China
    .

    The CONSIDER study suggests that 23.
    4% of hypertensive patients have diabetes; and the CCMR-3B study suggests that 59.
    8% of patients with type 2 diabetes have hypertension
    .

    When the two coexist, the patient is a high-risk or extremely high-risk group of cardiovascular risk.
    The risk of cardiovascular death and all-cause death can be increased by 6 times and 2.
    46 times compared with the general population, respectively, and the risk of macrovascular complications is also significantly increased
    .

     So, what kind of benefits will ARNI bring to patients with diabetes and hypertension? Professor Zhu Dalong, director of endocrinology at Nanjing Gulou Hospital, gave a high evaluation of ARNI, a new antihypertensive drug that was officially approved for hypertension indications on June 1.
    Let’s take a look! What about the current status of diabetes lowering blood pressure? The clinical needs are not met! For people with diabetes and hypertension, there is no doubt about the benefits of antihypertensive therapy.
    For every 10 mmHg decrease in systolic blood pressure, the risk of any diabetes-related complications can be reduced by 12%, the risk of diabetes-related death can be reduced by 17%, and the risk of microvascular complications It can be reduced by 13%, and the benefits of active blood pressure reduction are very obvious
    .

     However, it is regrettable that the data on the blood pressure compliance rate of diabetic patients in China is not optimistic.
    The CCMR-3B study suggests that the blood pressure compliance rate (<130/80 mmHg) in diabetic patients is less than 1/3, only 28.
    4%
    .

     Is this situation caused by insufficient drug dosage? The answer is obviously no
    .

     A meta-analysis of the relationship between the doses of commonly used antihypertensive drugs and antihypertensive efficacy suggests that whether thiazide diuretics, β-receptor blockers, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor antagonists are used ( ARB), the systolic blood pressure drop of monotherapy is generally about 10 mmHg, even if the dose is doubled, the antihypertensive effect is still limited (Figure 1)
    .

     Figure 1 Traditional antihypertensive drug treatments have limitations.
    Even if the dose is doubled, the antihypertensive effect is still limited.
    Faced with unmet clinical needs, we urgently need to develop a new mechanism of antihypertensive drugs, the first ARNI——Sakubatri Valsa The advent of Tan happened to meet this clinical need! What's new about sacubatril and valsartan? Past application experience has shown that ARB/ACEI can inhibit the renin-angiotensin-aldosterone system (RAAS) to achieve the purpose of lowering blood pressure
    .

    As a new sixth class of antihypertensive drugs, sacubitril and valsartan can inhibit RAAS while also enhancing the natriuretic peptide system
    .

     Natriuretic peptides can reduce blood pressure through neuroendocrine mechanisms (inhibiting RAAS and sympathetic nerve activity), vascular mechanisms (promoting vasodilation and resisting vasoconstriction), and renal mechanisms (urinating natriuresis and reducing blood volume).
    Blood vessels, natriuresis and diuresis, reduce blood pressure while inhibiting cardiac remodeling, delay renal function decline, and lower blood pressure more comprehensively and effectively (Figure 2)
    .

     Figure 2 The mechanism of action of natriuretic peptides.
    In terms of blood pressure reduction, sacubitril and valsartan mainly have the advantages of large blood pressure reduction, fast blood pressure reduction, and long-lasting blood pressure reduction effect: • Larger blood pressure reduction, mainly randomized for Asian populations Controlled studies have shown that with 8 weeks of treatment with sacubitril and valsartan, the maximum reduction in systolic blood pressure can reach 21 mmHg, which is better than that of olmesartan (Figure 3)
    .

    Figure 3 Sacubitril and valsartan are more effective than olmesartan in lowering blood pressure.
    • The blood pressure is lowered faster.
    An 8-week multicenter, open-label analysis of the use of sacubitril and valsartan in Japanese patients with severe hypertension over the age of 20 The curative effect of sartan was found to be 80% of the maximum blood pressure reduction after 1 week of sacubitril and valsartan, and as high as 91% after 2 weeks of treatment (Figure 4)
    .

     Figure 4 Sacubatril and Valsartan lowers blood pressure faster • The lowering of blood pressure is more durable, and it has a stronger inhibitory effect on night blood pressure.
    It can lower blood pressure for 24 hours.
    At the same time, long-acting drugs that can inhibit night blood pressure are the preferred lower blood pressure recommended by the guide.
    Drugs have also been proven to reduce the risk of different cardiovascular events
    .

     Studies have shown that sacubitril and valsartan treatment for 12 weeks can significantly reduce the 24-hour blood pressure, and the blood pressure drop at night is more obvious (Figure 5), which is better than olmesartan
    .

     Figure 5 Sacubatril and valsartan treatment for 12 weeks, significantly reducing 24-hour blood pressure and night blood pressure, which is better than olmesartan.
    Based on sufficient evidence-based evidence, "Asian Ambulatory Blood Pressure Monitoring Expert Consensus 2019" and "Chinese Ambulatory Blood Pressure Monitoring Guidelines" "2020" all clearly pointed out that sacubatril and valsartan can reduce 24-hour blood pressure and night blood pressure
    .

     In addition to large blood pressure reduction, fast speed and long-lasting effect, sacubitril and valsartan can also manage the entire cardiovascular event chain
    .

     The effect of sacubitril and valsartan on the improvement of heart failure and renal endpoints has also been confirmed by the PARADIGM-HF study and its chronic kidney disease (CKD) subgroup.
    Its enhancing effect on natriuretic peptides is more helpful in anti-arterial Hardening, anti-vascular proliferation, reducing pulse pressure, anti-vascular fibrosis
    .

     Therefore, sacubitril and valsartan have protective effects on multiple target organs such as heart, kidney, blood vessel, etc.
    , which can help break the chain of cardiovascular events and reduce the risk of primary endpoint events
    .

     The latest post-hoc analysis of the PARADIGM-HF study suggested that compared with enalapril, sacubitril and valsartan significantly reduced the level of glycosylated hemoglobin (HbA1c) in patients with heart failure and type 2 diabetes (Figure 6).
    Reduce the risk of patients using insulin by 29%
    .

    Regardless of the blood glucose status of patients with heart failure, sacubitril and valsartan significantly reduced the risk of the patient's primary endpoint compared with enalapril (Figure 7)
    .

    Figure 6 The use of sacubitril and valsartan is more effective than enalapril in lowering blood sugar.
    Figure 7 Regardless of the blood sugar status, sacubitril and valsartan significantly reduce the risk of the primary endpoint compared with enalapril.
    The above results confirm that the application of sacubitril and valsartan is more effective than enalapril.
    In addition to lowering blood pressure and protecting target organs, Cobatril valsartan also has the benefits of lowering blood sugar.
    It is undoubtedly the preferred antihypertensive drug for patients with diabetes and hypertension
    .

     Conclusion For hypertensive patients with diabetes, sacubitril and valsartan can intervene in the cardiovascular event chain throughout the whole process, play a protective effect on the target organs of the heart, kidneys, and blood vessels, and at the same time have the benefits of lowering blood sugar.
    It is a benefit for patients with diabetes and hypertension.
    Antihypertensive drugs are preferred
    .

     Expert profile Professor Zhu Dalong is a doctor of medicine, second-level chief physician, and professor
    .

    Doctoral supervisor of Nanjing University, Peking Union Medical College, Nanjing Medical University, director of the Endocrinology Department of Nanjing Gulou Hospital, and enjoys special government allowances from the State Council
    .

    Chairman of Diabetes Branch of Chinese Medical Association, Vice Chairman of Endocrinology and Metabolism Physician Branch of Chinese Medical Doctor Association, Deputy Editor-in-Chief of J Diabetes, Editor-in-Chief of Endocrine Reviews Chinese Edition, Chinese Edition of Diabetes Care, Chinese Edition of Diabetes, Deputy Editor-in-Chief of Chinese Journal of Diabetes
    .

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