DISCUSSION
DBP reductions, hypertension, Hg reduction
HYPERTENSION
This analysis confirms the 24‐hour BP‐lowering effects of the angiotensin receptor neprilysin inhibitor sacubitril/valsartan in Japanese patients with mild‐to‐moderate hypertension and shows that these effects are greater than those of a midrange dose of the angiotensin receptor blocker olmesartan. Furthermore, we have also demonstrated that sacubitril/valsartan is an effective antihypertensive agent regardless of the nocturnal BP dipping profile and in various patient subgroups. Sacubitril/valsartan had similar antihypertensive effects on all ambulatory BP measures (24‐hour, daytime, and nighttime), although reductions in nighttime BP were slightly greater than the other 2 measures. This indicates consistent BP‐lowering effects throughout 24 hours with good antihypertensive coverage overnight and in the early morning predosing period.In the current analysis, reductions from baseline in 24‐hour, daytime, and nighttime ambulatory SBP over 8 weeks of treatment with sacubitril/valsartan exceeded 12 mm Hg, and DBP reductions were all above 7 mm Hg (Figure Overall, the number of responders to treatment with sacubitril/valsartan was significantly higher than the number of responders to treatment with olmesartan, indicating the superior 24‐hour BP‐lowering efficacy of sacubitril/valsartan. Although a small proportion of patients had a change in 24‐hour BP of <5 mm Hg, most had reductions of ≥5 mm Hg, and some had a substantial response, with a ≥20 mm Hg reduction in 24‐hour BP during treatment (Figure The novel finding of this study is the differences in the BP‐lowering effects of sacubitril/valsartan between patients with a dipper versus nondipper profile of nighttime BP (Figures This study was conducted in Japanese patients, and there is evidence to suggest that angiotensin receptor neprilysin inhibitor drugs may be ideally suited for the treatment of hypertension in Asian populations.Although the data used were generated in a randomized controlled clinical trial, the post hoc analysis was not prespecified. The post hoc nature of this analysis means that potential sources of bias cannot be excluded. Therefore, the findings require confirmation in a prospective clinical study. In addition, only a single midrange dose of olmesartan was used as the comparator, and therefore both agents studied were not investigated across their full dosage range. Another limitation of the study was the single ethnicity population (Japanese), limiting the external generalizability of the findings.