Sacubitril/valsartan significantly reduced major adverse cardiovascular events compared to amlodipine in elderly patients with coronary artery disease and hypertension, with a hazard ratio of 0.38 (95% CI: 0.18-0.80), while also improving blood pressure control and left ventricular ejection fraction.
Key Findings
Results
Sacubitril/valsartan treatment was associated with a significantly lower incidence of MACE compared to amlodipine over 12 months.
MACE incidence was 10.26% in the sacubitril/valsartan group versus 27.14% in the amlodipine group (P = 0.008)
Primary MACE composite endpoint included aggravated heart failure and arrhythmia events
A sensitivity analysis used a conventional MACE definition (myocardial infarction, stroke, cardiovascular death, revascularization), excluding isolated ventricular premature beats
Both groups received conventional therapy in addition to the study drug
The study followed 150 elderly patients with CAD and hypertension over 12 months
Results
Cox regression analysis identified sacubitril/valsartan as an independent protective factor against cardiovascular adverse events.
Hazard ratio (HR) = 0.38, 95% confidence interval (CI): 0.18-0.80, P = 0.011
Cox proportional hazards regression was used to control for confounding factors
The HR of 0.38 indicates approximately a 62% reduction in the hazard of cardiovascular adverse events with sacubitril/valsartan
Results
Patients treated with sacubitril/valsartan demonstrated superior blood pressure control compared to those treated with amlodipine.
Blood pressure control was a secondary endpoint in the study
Both regimens were combined with conventional therapy
The study population consisted of elderly patients with both CAD and hypertension, a group requiring careful blood pressure management
Results
Sacubitril/valsartan treatment was associated with improved left ventricular ejection fraction (LVEF) compared to amlodipine.
LVEF improvement was a pre-specified secondary endpoint
Cardiac function parameters were among the secondary endpoints assessed
LVEF is a key measure of cardiac systolic function and a clinically important marker in patients with CAD
Results
Both sacubitril/valsartan and amlodipine regimens were well-tolerated in elderly patients with CAD and hypertension.
No severe adverse events were reported in either treatment group
Treatment-related adverse events were a pre-specified secondary endpoint
The study enrolled 150 elderly patients, a population typically considered at higher risk for drug intolerability
The tolerability profile supports the feasibility of sacubitril/valsartan use in this specific elderly population
Methods
The study enrolled elderly patients with concurrent CAD and hypertension, a population with limited existing evidence for sacubitril/valsartan use.
Total enrollment was 150 elderly patients
This was a retrospective cohort study design
The study compared sacubitril/valsartan versus amlodipine, both combined with conventional therapy
Follow-up duration was 12 months
Prior evidence for sacubitril/valsartan had been primarily established in heart failure management, not this specific comorbid population
What This Means
This research suggests that sacubitril/valsartan, a medication originally developed for heart failure, may be beneficial for elderly patients who have both coronary artery disease (narrowed heart arteries) and high blood pressure. In this study of 150 elderly patients followed for one year, those treated with sacubitril/valsartan alongside standard care had a much lower rate of serious heart-related complications (about 10%) compared to those treated with amlodipine, a common blood pressure medication (about 27%). Statistical analysis showed that sacubitril/valsartan was associated with roughly a 62% lower risk of cardiovascular complications, and this benefit held up even after accounting for other factors that might influence outcomes.
Beyond reducing serious cardiac events, sacubitril/valsartan also appeared to provide better blood pressure control and improvements in how well the heart pumps blood (measured by left ventricular ejection fraction). Importantly, both medications were well-tolerated, with no severe side effects reported in either group, suggesting that sacubitril/valsartan is manageable even in an elderly population that is often more sensitive to medication side effects.
This research suggests that sacubitril/valsartan could be a valuable treatment option for elderly people managing both coronary artery disease and hypertension simultaneously — a common and high-risk combination. However, because this was a retrospective cohort study (looking back at existing patient data) with a relatively small sample size of 150 patients at a single timepoint, larger prospective randomized trials would be needed to confirm these findings and establish definitive clinical guidelines for this patient population.
Feng M, Xie Y. (2026). Sacubitril/Valsartan Improves Cardiovascular Outcomes in Elderly Patients with Coronary Artery Disease and Hypertension: A Retrospective Cohort Study.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/72402