Jackson AM, Jhund PS, Anand IS, et al. - Patients with heart failure and preserved ejection fraction (HFpEF) who present with apparent resistant hypertension may benefit from receiving treatment with sacubitril–valsartan; benefit may appear even in those who continue to have an elevated blood pressure despite treatment with at least four antihypertensive drug classes, including an mineralocorticoid receptor antagonist (MRA).

• In this post hoc analysis, the effect of neprilysin inhibition was determined on ‘apparent resistant hypertension’ in patients with HFpEF in the PARAGON-HF trial, which compared the effect of sacubitril–valsartan with valsartan.

• Systolic blood pressure ≥ 140 mmHg (≥ 135 mmHg if diabetes) despite treatment with valsartan, a calcium channel blocker, and a diuretic defined ‘apparent resistant hypertension’.

• There were 731 patients (15.2%) with apparent resistant hypertension and 135 (2.8%) with apparent MRA-resistant hypertension.

• Relative to patients with a controlled systolic blood pressure, those with apparent resistant hypertension had a higher rate of the primary outcome (a composite of total hospitalizations for heart failure and death from cardiovascular causes).

• With sacubitril–valsartan vs valsartan, patients with apparent resistant hypertension and apparent MRA-resistant hypertension showed greater reduction in systolic blood pressure at Weeks 4 and 16, respectively.

• In the sacubitril–valsartan and valsartan group, a controlled systolic blood pressure was achieved by Week 16 in 47.9% and 34.3% patients with apparent resistant hypertension, respectively.

• The respective proportions were 43.6% vs 28.4% in patients with apparent MRA-resistant hypertension.