The Chinese Expert Consensus Recommendations on the Clinical Application of Sacubitril/valsartan in Patients With Hypertension document was recently published in the Chinese Journal of Hypertension (2021; 29(2): 108-114). The recommendations were jointly compiled by the hypertension branch of the China International Exchange and Promotive Association for Medical and Health Care, the cardiovascular branch of the Chinese Medical Doctor Association, and the Chinese Hypertension League. Because it is the first expert consensus on the treatment of hypertension using angiotensin receptor neprilysin inhibitor (ARNI), it is expected to serve as an important reference for developing standardized clinical application protocols for this drug.

Hypertension is the main cause of death in China. Currently, the control rate of hypertension in China is less than 20%. Patients with hypertension have a high risk of organ damage and other cardiovascular disease. In current clinical practice, there is no standard strategy that simultaneously reduces blood pressure while preventing organ damage and protecting the entire cardiovascular continuum in patients with hypertension. The pathophysiological mechanisms of essential hypertension are diverse, and there is an urgent need for new antihypertensive drugs that can regulate blood pressure through multiple mechanisms and confer protection to the cardiovascular continuum. In this regard, sacubitril/valsartan comprises a breakthrough and an important step forward.

Sacubitril/valsartan is the first ARNI drug available on the market worldwide. This drug has two components in its unique co-crystal structure that act synergistically to bring out therapeutic effects. Sacubitril inhibits neprilysin activity, thereby increasing the body's levels of natriuretic peptides, which then reduce blood pressure and protect organs, while valsartan effectively counteracts activation of the renin-angiotensin-aldosterone system (RAAS). Co-crystallization allows similar absorption and elimination rates of sacubatril and valsartan, thus ensuring that their efficacy is synchronized, in order to achieve multi-target blood pressure reduction. A total of 14 sacubitril/valsartan trials achieved great results for different types of hypertension, including: grade 1 and 2 hypertension, refractory hypertension, hypertension in the elderly, salt-induced hypertension among others. Professor Yong Huo led one of the aforementioned clinical trials, comprising 1,450 Asian hypertensive patients, 85% of whom are Chinese. In comparison with olmesartan, ANRI was more effective at lowering blood pressure. Many studies and meta-analyses have confirmed that the ANRI can significantly lower blood pressure in essential hypertension, and it has a superior protective effect on target organs, such as the heart, kidneys, and blood vessels. Therefore, ANRIs can protect the cardiovascular continuum and reduce the risk of cardiovascular events.

Currently, China's National Medical Products Administration has accepted the application of sabacutril/valsartan for the treatment of hypertension. Although sacubitril/valsartan is widely used in the treatment of heart failure, it is a new drug in the field of hypertension. The Chinese Expert Consensus Recommendations on the Clinical Application of Sacubitril/Valsartan in Patients with Hypertension document is expected to guide clinicians on the use of ARNIs in the treatment of hypertension, and to develop standardized clinical application protocols for this drug. This document details the antihypertensive mechanisms of sacubitril/valsartan, the evidence of its efficacy, the scope of clinical application and how it can be applied in the treatment of hypertension.

In the near future, ARNI drugs are expected to become a standard treatment for hypertension. A new class of antihypertensive drugs, it is recommended by both Chinese and international guidelines. We look forward to working together with other experts to make this a reality.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: ACC International, Antihypertensive Agents, Renin-Angiotensin System, Neprilysin, Blood Pressure, Pharmaceutical Preparations, Receptors, Angiotensin, Crystallization, Heart Failure, Natriuretic Peptides, Asian Continental Ancestry Group, Delivery of Health Care

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