ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Hypertension
Effects of Sacubitril/Valsartan on Ventricular Remodeling in Patients with Hypertension and Maintenance Hemodialysis: A Retrospective Cohort Study
Shaofa Wu 1
Lili Jiang 2
Xu Min 1
Jing Ran 1
Yu Zhu 1
Lupin Pan 2
Bayi Yang 1
Xue Ran 1
Ying Ran 1
Hejun Ding 1
Jurong Yang 2
1. First Affiliated Hospital of Chongqing Medical University, Chongqing, China
2. The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Abstract 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) versus 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.
Summary
Keywords
Hypertension, left ventricular hypertrophy, Maintenance hemodialysis, sacubitril/valsartan, Ventricular Remodeling
Received
28 December 2025
Accepted
11 February 2026
Copyright
© 2026 Wu, Jiang, Min, Ran, Zhu, Pan, Yang, Ran, Ran, Ding and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shaofa Wu
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