Effects of sacubitril/valsartan on ventricular remodeling in patients with hypertension and maintenance hemodialysis: a retrospective cohort study.

BACKGROUND

Left ventricular hypertrophy (LVH), a hallmark of pathological ventricular remodeling, is highly prevalent and strongly predicts mortality in patients undergoing maintenance hemodialysis (MHD). This study aimed to compare the efficacy of sacubitril/valsartan (SV) vs. angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) on ventricular remodeling in hypertensive MHD patients.

METHODS

In this single-center retrospective cohort study conducted between January 2023 and June 2025, 111 hypertensive patients undergoing MHD for at least 3 months were divided into SV (n = 46) and ACEi/ARB (n = 65) groups based on their antihypertensive regimen. The primary endpoint was the change in left ventricular mass index (LVMI) after 6 months. Secondary endpoints included changes in blood pressure, other echocardiographic parameters, NT-proBNP, and safety outcomes.

RESULTS

The mean age was 56.17 ± 13.47 years and 68.5% were male. After 6 months, LVMI significantly decreased in the SV group (-5.52 g/m2, 95% CI -9.35 to -1.69, P = 0.006) but not in the ACEi/ARB group (1.11 g/m2, 95% CI -3.27 to 5.50, P = 0.615). Two-way repeated measures ANOVA revealed a significant group × time interaction for LVMI (P = 0.033). Both groups achieved significant blood pressure reductions: systolic blood pressure decreased by 9.81 mmHg (P < 0.001) in the ACEi/ARB group and by 10.46 mmHg (P < 0.001) in the SV group. New-onset intradialytic hypotension occurred in 7 (6.3%) patients and hyperkalemia in 9 (8.1%) patients, with similar incidences between groups and no treatment discontinuations.

CONCLUSIONS

Compared to ACEi/ARB, SV is more effective in reversing ventricular remodeling in hypertensive MHD patients.