Frontiers in Cardiovascular Medicine · Nov 7, 2026
Sacubitril/Valsartan versus Conventional Antihypertensive Therapy in Patients with Hypertension and Type 2 Diabetes
By Jiwen Liu, Baocheng Zhu, Ting Huang et al.
Objective To investigate the associations of angiotensin receptor neprilysin inhibitors (ARNI) use with clinical outcomes compared with conventional antihypertensive therapy in patients with hypertension and comorbid diabetes. Methods A retrospective observational study initially identified 218 patients with hypertension and type 2 diabetes admitted between January and June 2022. After 1:1 propensity score matching, 212 patients (106 per group) were included in the final analysis. Patients were divided by actual clinical treatment: conventional therapy group (n=106) received metformin (0.5g twice daily) plus glimepiride (1-4 mg/day) for glycemic control, and adjustable antihypertensive regimens (Angiotensin-Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs): enalapril 5-20mg, losartan 50-100mg; Calcium Channel Blockers (CCBs): amlodipine 2.5-10mg; diuretics: hydrochlorothiazide 12.5-25mg); ARNI group (n=106) received sacubitril/valsartan (200-400 mg/day) with CCBs/diuretics added if needed. Results At 6 months, greater reductions in systolic/diastolic blood pressure were observed in the ARNI group compared to conventional therapy and a higher blood pressure control rate compared to the conventional therapy group, with no differences in antihypertensive drug types or adverse reactions. At 12 months, the ARNI group exhibited numerically lower rates of myocardial infarction (MI) and heart failure (HF) hospitalization, although these associations were not statistically significant after Bonferroni correction for multiple comparisons. In patients with uncontrolled baseline blood pressure (BP), ARNI was associated with a nominally lower risk of composite cardiovascular events (HR = 0.59, 95% CI: 0.32–0.97); this subgroup finding was exploratory and not adjusted for multiple testing. The ARNI group had higher eGFR and more favorable renal and metabolic markers at 6 and 12 months, with no significant difference in hypoglycemia or other adverse reactions. Conclusion In this retrospective study, sacubitril/valsartan was associated with better blood pressure control and favorable renal and glycemic outcomes. Cardiovascular event rates were numerically lower but did not remain statistically significant after Bonferroni correction and should therefore be considered exploratory. These findings are limited by residual confounding, baseline imbalances, and insufficient statistical power for cardiovascular outcomes. Given the observational design, these findings should be interpreted as hypothesis-generating. Prospective randomized trials are needed to confirm whether ARNI confers incremental favorable outcomes compared with conventional therapy in this population.