Sacubitril/valsartan reduced pulmonary artery pressure by a median of 30% in peritoneal dialysis patients with heart failure and pulmonary hypertension — significantly better than standard ARB therapy at just 8.6% reduction.
30% reduction in pulmonary artery pressureSacubitril/valsartan achieved a median 30% reduction in pulmonary artery pressure over 3 months, compared to just 8.6% with standard ARB therapy in peritoneal dialysis patients.
What the researchers found
After three months of sacubitril/valsartan treatment, median pulmonary artery pressure in peritoneal dialysis patients dropped from 48.00 mmHg to 33.00 mmHg (P<0.001).
The percentage reduction in pulmonary artery pressure was -30.0% with sacubitril/valsartan versus -8.6% with ARB alone (P<0.001) — more than three times greater.
Heart failure biomarkers NT-proBNP (N-terminal B-type natriuretic peptide precursor) and cardiac troponin I were both significantly reduced after sacubitril/valsartan treatment. Left ventricular remodeling was also attenuated. Standard ARB therapy did not show significant advantages compared to sacubitril/valsartan on any of these measures.
Why it matters
Peritoneal dialysis patients with heart failure and pulmonary hypertension have very limited treatment options and high mortality. Sacubitril/valsartan works by inhibiting neprilysin — the enzyme that breaks down beneficial natriuretic peptides like BNP and ANP — effectively boosting the body's natural peptide-based cardiovascular protection system. This study provides the first evidence that this natriuretic peptide-enhancing strategy can meaningfully reduce pulmonary pressures in this vulnerable patient population.
How the study worked
Prospective comparative study with 145 peritoneal dialysis patients with heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension receiving sacubitril/valsartan, and 38 control patients treated with standard angiotensin receptor blocker (ARB). Patients were followed for 3 months. Efficacy was assessed through biochemical parameters (NT-proBNP, cardiac troponin I), echocardiographic indicators (pulmonary artery pressure, cardiac remodeling measures), and adverse reaction monitoring.
What this study cannot tell us
The study is not randomized — patients were assigned to groups rather than randomized, introducing potential selection bias. The groups are significantly unbalanced (145 vs. 38 patients). Three months of follow-up is relatively short, and longer-term outcomes including mortality are not reported. The study is from a single center, limiting generalizability. Heart failure with preserved ejection fraction is a heterogeneous condition, and results may not apply to all HFpEF subtypes. Specific sacubitril/valsartan doses are not detailed in the abstract.
How to read the evidence
This is a non-randomized comparative study with unbalanced groups (145 vs. 38). While the results are striking and statistically significant, the lack of randomization means confounding factors could influence outcomes. The evidence is moderate — stronger than observational data but weaker than a randomized controlled trial.
When this study was published
Published in 2025, this is a very recent study addressing a gap in evidence for treating pulmonary hypertension in dialysis patients. Larger randomized trials would strengthen these findings.
The bigger picture
Sacubitril/valsartan (Entresto) revolutionized heart failure treatment by harnessing the natriuretic peptide system — instead of replacing peptides, it prevents their degradation, amplifying their natural beneficial effects. This study extends its potential benefits to dialysis patients, a population traditionally excluded from major heart failure trials. The growing evidence for natriuretic peptide modulation in diverse cardiovascular conditions reinforces the central importance of these cardiac peptides in maintaining cardiovascular health.
Questions still open
- Does the reduction in pulmonary artery pressure translate to improved survival in this high-risk dialysis population?
- Would similar benefits be seen in hemodialysis patients, or is there something specific about peritoneal dialysis that affects the response?
- How do natriuretic peptide levels themselves change during treatment — does sacubitril/valsartan normalize the peptide imbalance in these patients?
Common questions
How does sacubitril/valsartan use natriuretic peptides to lower blood pressure?
Why is pulmonary hypertension dangerous for dialysis patients?
Read the original research
Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension among PD patients.
International urology and nephrology, 57(11), 3879-3888
Citation
Guo, Yanhong; Zhao, Silu; Zhang, Xuewen; Gou, Rong; Wang, Liuwei; Wang, Yulin; Zhai, Zihan; Yu, Lu; Tang, Lin. (2025). Sacubitril/valsartan affects pulmonary arterial pressure in heart failure with preserved ejection fraction and pulmonary hypertension among PD patients.. International urology and nephrology, 57(11), 3879-3888. https://doi.org/10.1007/s11255-025-04580-5