Efficacy and Safety of LCZ696A in Patients With Essential Hypertension

• Change From Baseline in Mean Sitting Systolic Blood Pressure (msSBP) [ Time Frame: baseline, week 8 ]
  Sitting BP measurements were performed at screening through the end of the study at every study visit.
• Change From Baseline in 24-hour Mean Ambulatory DBP (maDBP) and maSBP [ Time Frame: baseline, 8 weeks ]
  Hourly mean ambulatory DBP and SBP post-dosing was calculated for each post-dosing hour over 24 hours by taking the average of the readings taken in the corresponding post-dosing hour at randomization and at week 8.
• Change From Baseline in Daytime maDBP and maSBP [ Time Frame: baseline, 8 weeks ]
  Hourly mean ambulatory DBP and SBP post-dosing was calculated for each post-dosing hour over 24 hours by taking the avergae of the readings taken in the corresponding post-dosing hour at randomization and at week 8. Daytime mean SBP and DBP were the averages of the hourly means between 6 am and 10 pm.
• Change From Baseline in Nighttime maDBP and maSBP [ Time Frame: baseline, 8 weeks ]
  Hourly mean ambulatory DBP and SBP post-dosing was calculated for each post-dosing hour over 24 hours by taking the average of the readings taken in the corresponding post-dosing hour at randomization and at week 8. Nighttime mean SBP and DBP were the averages of the hourly means between 10 pm and 6 am.
• Percentage of Participants Who Achieved a Successful Response in msDBP [ Time Frame: 8 weeks ]
  Successful response in msDBP is defined as msDBP <90 mmHg or a reduction ≥ 10 mmHg from baseline.
• Percentage of Participants Who Achieved a Successful Response in msSBP [ Time Frame: 8 weeks ]
  Successful response in msSBP is defined as msSBP <140 mmHg or a reduction ≥ 20 mmHg from baseline.
• Percentage of Participants Who Achieved Successful Control in msDBP [ Time Frame: 8 weeks ]
  Successful control in msDBP is defined as msDBP <90 mmHg.
• Percentage of Participants Who Achieved Successful Control in msSBP [ Time Frame: 8 weeks ]
  Successful control in msSBP is defined as <140 mmHg.

• Drug: LCZ696
• Drug: Valsartan
• Drug: AHU377
• Drug: Placebo

• Experimental: LCZ696 100 mg
  Participants received LCZ696 100 mg and matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: LCZ696
  • Drug: Placebo
• Experimental: LCZ696 200 mg
  Participants received LCZ696 200 mg and matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: LCZ696
  • Drug: Placebo
• Experimental: LCZ696 400 mg
  Participants received LCZ696 400 mg (200 mg LCZ696 for one week and then up-titration to 400 mg LCZ696 for 7 weeks) and matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: LCZ696
  • Drug: Placebo
• Active Comparator: Valsartan 80 mg
  Participants received Valsartan 80 mg and matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: Valsartan
  • Drug: Placebo
• Active Comparator: Valsartan 160 mg
  Participants received Valsartan 160 mg and matching placebo to LCZ696, Valsatan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: Valsartan
  • Drug: Placebo
• Active Comparator: Valsartan 320 mg
  Participants received Valsartan 320 mg (160 mg valsartan capsules for one week followed by 320 mg valsartan capsules for 7 weeks) and matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: Valsartan
  • Drug: Placebo
• Experimental: AHU377 200 mg
  Participants received AHU377 200 mg and matching placebo to LCZ696 and Valsartan (5 tablets and 2 capsules) daily.
  Interventions:

  • Drug: AHU377
  • Drug: Placebo
• Placebo Comparator: Placebo
  Participants received matching placebo to LCZ696, Valsartan and AHU377 (5 tablets and 2 capsules) daily.
  Intervention: Drug: Placebo

• Andersen MB, Simonsen U, Wehland M, Pietsch J, Grimm D. LCZ696 (Valsartan/Sacubitril)--A Possible New Treatment for Hypertension and Heart Failure. Basic Clin Pharmacol Toxicol. 2016 Jan;118(1):14-22. doi: 10.1111/bcpt.12453. Epub 2015 Sep 4. Review.
• Ruilope LM, Dukat A, Böhm M, Lacourcière Y, Gong J, Lefkowitz MP. Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angiotensin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study. Lancet. 2010 Apr 10;375(9722):1255-66. doi: 10.1016/S0140-6736(09)61966-8. Epub 2010 Mar 16.

Inclusion Criteria:

• Male or females from 18 up to and including 75 years
• Patients with mild-to-moderate uncomplicated essential hypertension, untreated or currently taking antihypertensive therapy (monotherapy or combination therapy of 2 drugs; therapy with a fixed dose combination of two active substances represents 2 drugs)
• Untreated patients must have had an office msDBP≥ 95 mmHg at the randomization visit (Visit 3) and the 2 preceding visits (Visits 1 and 2).
• Treated patients must have had an office msDBP≥ 90 mmHG after washout (Visit 2), and a msDBP> 95 mmHg at baseline (Visit 3);

Exclusion Criteria:

• Severe hypertension (msSBP ≥180 mmHg and/or msDBP ≥110 mmHg)
• History of angioedema, drug-related or otherwise, as reported by the patient
• Type 1 or Type 2 diabetes mellitus (according to the ADA criteria)
• History or evidence of a secondary form of hypertension, such as renal parenchymal hypertension, renovascular hypertension, coarctation of the aorta, primary hyperaldosteronism, Cushing's disease, drug-induced hypertension, unilateral or bilateral renal artery stenosis, pheochromocytoma, polycystic kidney disease, etc.
• History of angina pectoris, myocardial infarction, coronary bypass surgery, ischemic heart disease, surgical or percutaneous arterial intervention of any kind (coronary, carotid or peripheral intervention), stroke, TIA (transient ischemic attack), carotid artery stenosis, aortic aneurysm or peripheral arterial disease