According to a post-hoc analysis published in the ‘European Heart Journal’, the combined use of the drugs sacubitril–valsartan was more effective than valsartan alone in reducing blood pressure in patients with apparent resistant hypertension, including those with mineralocorticoid receptor antagonist (MRA)-resistant hypertension. This analysis included 4796 patients from the ‘PARAGON-HF’ trial.

The key results were as follows:

• The reduction in systolic blood pressure was greater with sacubitril-valsartan compared to only valsartan in patients with apparent resistant hypertension and apparent MRA-resistant hypertension.
• A significantly higher proportion of patients in the sacubitril-valsartan group with apparent resistant hypertension achieved a controlled systolic blood pressure compared to the only valsartan group.

Therefore, this post hoc analysis states that sacubitril-valsartan may be useful in treating apparent resistant hypertension in patients with heart failure and preserved ejection fraction (HFpEF), even in those who continue to have an elevated blood pressure despite treatment with at least four antihypertensive drug classes.