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Effects of sacubitril/valsartan on hypertensive heart disease: the REVERSE-LVH randomized phase 2 trial
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Effects of sacubitril/valsartan on hypertensive heart disease: the REVERSE-LVH randomized phase 2 trial
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Journal Article
Effects of sacubitril/valsartan on hypertensive heart disease: the REVERSE-LVH randomized phase 2 trial
2025
Overview
Diffuse interstitial fibrosis is associated with adverse outcomes in hypertensive heart disease and may be reversible. Sacubitril/valsartan could offer greater anti-fibrotic effects than valsartan alone. In the REVERSE-LVH phase 2 open-labelled trial (clinicaltrials.gov NCT: 03553810; funded by the National Medical Research Council of Singapore), 78 patients with essential hypertension and left ventricular hypertrophy (LVH) were randomized 1:1 to sacubitril/valsartan or valsartan for 52 weeks. Primary endpoint was a change in interstitial volume, assessed using cardiovascular magnetic resonance. Despite similar 24-hour systolic blood pressure at 52 weeks (125 ± 11 vs. 126 ± 11 mmHg;
P
= 0.762), sacubitril/valsartan resulted in a greater absolute reduction in interstitial volume compared to valsartan (−5.2 ± 5.4 vs. −2.5 ± 3.1 mL;
P
= 0.006). Secondary endpoints showed significant differences favoring sacubitril/valsartan in LV mass, left atrial volume, estimated LV filling pressure, and improved cardiac circulating biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T). Other markers of cardiac volumes, function and mechanics were similar between the two treatment arms. Here we show the potential myocardial benefits of sacubitril/valsartan beyond blood pressure control, though larger studies are needed to confirm their clinical relevance.
Here the authors compare the efficacy between sacubitril/valsartan and valsartan in improving diffuse myocardial fibrosis in patients with hypertensive heart disease, assessed as change in interstitial volume with cardiovascular magnetic resonance. The results show potential myocardial benefits of sacubitril/valsartan beyond blood pressure control.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ 692/4019
/ Aged
/ Aminobutyrates - administration & dosage
/ Aminobutyrates - therapeutic use
/ Angiotensin Receptor Antagonists - therapeutic use
/ Antihypertensive Agents - therapeutic use
/ Blood Pressure - drug effects
/ Enzymes
/ Female
/ Fibrosis
/ Humanities and Social Sciences
/ Humans
/ Hypertension - complications
/ Hypertrophy, Left Ventricular - diagnostic imaging
/ Hypertrophy, Left Ventricular - drug therapy
/ Hypertrophy, Left Ventricular - physiopathology
/ Male
/ Natriuretic Peptide, Brain - blood
/ Patients
/ Science
/ Tetrazoles - therapeutic use
/ Troponin
