From the Guidelines
Entresto (sacubitril/valsartan) has a similar or slightly greater blood pressure lowering effect compared to lisinopril 40 mg, due to its dual mechanism of action as an angiotensin receptor blocker and neprilysin inhibitor. The combination of valsartan and sacubitril in Entresto provides a more consistent blood pressure reduction than ACE inhibitors alone, such as lisinopril 1. The standard dose of Entresto (97/103 mg twice daily) contains valsartan 160 mg per dose, which, along with the neprilysin inhibition, can produce a more significant blood pressure lowering effect. Neprilysin inhibition increases levels of natriuretic peptides, promoting vasodilation and sodium excretion, and enhancing the blood pressure lowering effect beyond what is typically seen with ACE inhibitors like lisinopril 1.
Some key points to consider when comparing Entresto and lisinopril include:
- Entresto is primarily indicated for heart failure with reduced ejection fraction, while lisinopril is commonly used for both heart failure and hypertension
- Individual responses to the medications may vary, with some patients responding better to one medication than the other
- A washout period is necessary when switching between these medications to avoid the risk of angioedema, and blood pressure should be monitored closely during the transition 1
- The benefits of ACE inhibitors, such as lisinopril, in decreasing heart failure progression, hospitalizations, and mortality rate have been consistently shown, but Entresto has been found to provide additional benefits in patients with mild-to-moderate heart failure who can tolerate both an ACE inhibitor and an ARNI 1.
Overall, while both medications can be effective in lowering blood pressure, Entresto's unique mechanism of action and potential for additional benefits in certain patient populations make it a valuable treatment option for patients with heart failure with reduced ejection fraction.
From the Research
Comparison of Entresto and Lisinopril
- Entresto (Sacubitril/Valsartan) is an angiotensin receptor neprilysin inhibitor that has been shown to be effective in reducing blood pressure and improving cardiac outcomes in patients with heart failure 2, 3, 4.
- Lisinopril is an Angiotensin Converting Enzyme Inhibitor (ACEI) that is commonly used to treat hypertension and heart failure 2.
- A study comparing the efficacy of Entresto and enalapril (another ACEI) found that Entresto was superior in reducing mortality, hospitalizations, and heart failure symptoms 4.
- Another study found that Entresto reduced blood pressure and improved cardiac structural and functional parameters in hypertensive patients with heart failure, even at lower doses 3.
- In terms of blood pressure lowering, Entresto has been shown to be effective in reducing systolic blood pressure by 12.8 mmHg and diastolic blood pressure by 7.1 mmHg in patients with heart failure and hypertension 3.
- While there is no direct comparison between Entresto and lisinopril 40 mg, a study found that sacubitril-valsartan (Entresto) was effective in treating apparent resistant hypertension in patients with heart failure and preserved ejection fraction, with a greater reduction in systolic blood pressure compared to valsartan 5.
Efficacy of Entresto in Different Patient Populations
- Entresto has been shown to be effective in patients with heart failure and reduced ejection fraction, including those with advanced chronic kidney disease and hypotension 6.
- In patients with apparent resistant hypertension, Entresto was found to be effective in reducing blood pressure and improving cardiac outcomes, even in those who continued to have an elevated blood pressure despite treatment with at least four antihypertensive drug classes 5.
- The efficacy of Entresto in different patient populations, including those with different ages, renal functions, and comorbidities, has been demonstrated in several studies 3, 5, 6.