Findings demonstrate safety as well as effectiveness of sacubitril/valsartan (SV) in controlling resistant hypertension and improving myocardial work (MW) as well as life quality of hemodialysis patients.

• Impact of SV on antihypertension and cardiac protection in the general population has been corroborated by growing evidence.

• In this single-center, prospective analysis, 18 patients (34–64 years old) with resistant hypertension for more than 6 months were initially administered SV 50 mg twice daily, and the dosage was slowly increased up to 100 mg twice daily, to determine the effect and safety of SV on resistant hypertension and myocardial work in hemodialysis patients.

• Relative to baseline, significantly mean sitting systolic BP and mean sitting diastolic BP reductions (-20.7/-8.3 mm Hg), respectively, were achieved with SV-based regimen.

• Partial improvement in cardiac remodeling parameters was evident.

• Relative to the baseline, there was significant reduction in N-terminal pro-B-type natriuretic peptide at week 4, which was much lower at week 12.

• Higher global MW index at week 12 from baseline was obtained.

• At week 12, improvements were seen in life quality and fatigue.

• No serious adverse events occurred.