Implication of sacubitril/valsartan on N-terminal pro B-type natriuretic peptide levels in hypertensive patients

Background: Even a slight increase in plasma N-terminal-pro B-type natriuretic peptide (NT-pro BNP) levels is associated with an incremental cardiovascular risk in a healthy cohort. Sacubitril/valsartan has recently been reimbursed in Japan for hypertension. Its impact on reducing plasma NT-pro BNP levels in hypertensive patients remains unknown. Methods: Patients who received 3-month sacubitril/valsartan treatment for their hypertension were retrospectively included. Changes in plasma NT-pro BNP levels during 3-month sacubitril/valsartan therapy ( on-treatment period) were compared with those during pre-treatment 3-month period without sacubitril/valsartan (pre-treatment period). Results: A total of 33 hypertensive patients {73 [64, 77] years old and systolic blood pressure 138 [134, 149] mmHg on median} were included. During a pre-treatment period, systolic blood pressure tended to decrease (P=0.091) whereas plasma NT-pro BNP levels remained unchanged (from 204 [132, 412] to 207 [107, 386] pg/mL, P=0.84}. During on-treatment period, both systolic pressure and plasma NT-pro BNP levels decreased significantly (P<0.001 and P=0.001, respectively, from 207 [107, 386] to 119 [64, 355] pg/mL in NT-pro BNP}. The amount of changes in plasma NT-pro BNP levels during on-treatment period was significantly higher than those during pre-treatment period {-51 [-158, -17] versus -12 [-28, 33] mmHg, P=0.001}. Conclusions: Plasma NT-pro BNP levels decreased significantly following 3-month sacubitril/valsartan therapy. Its clinical implication requires further long-term studies.