老年患者收缩期高血压的有效治疗仍然是主要的治疗挑战。一个多中心，双盲,沙库巴曲/缬沙坦的随机对照试验（LCZ696），一类血管紧张素受体脑啡肽酶抑制剂，进行，以确定其效果与奥美沙坦（血管紧张素受体阻滞剂）对中央主动脉压，在收缩期高血压和脉压>60mmHg的老年患者（年龄≥60岁）中，表明动脉僵硬。患者(n=454；平均年龄，67.7年；平均坐位收缩压，158.6mmHg；平均固定脉压，69.7mmHg）随机接受每日一次的沙库巴曲/缬沙坦200mg或奥美沙坦20mg，力滴定到4周后的初始剂量加倍，在12周时进行初步评估之前。这项研究延长了12至52周的双盲治疗，在此期间，氨氯地平（2.5-5mg）和随后的氢氯噻嗪（6.25-25mg）用于未达到血压目标（<140/90）的患者。在第12周，沙库巴曲/缬沙坦降低中心主动脉收缩压（主要评估）比奥美沙坦降低-3.7mmHg（P=0.010），在第12周的二级评估进一步证实（中央主动脉脉压，-2.4mmHg,P<0.012；平均24小时动态肱动脉收缩压和中央主动脉收缩压，-4.1mmHg和-3.6mmHg，分别,两者P<0.001)。睡眠期间24小时动态压力的差异很明显。52周后,不同治疗组的血压参数相似(P<0.002);然而,与沙库巴曲/缬沙坦(32%;P<0.002)相比,更多的患者需要奥美沙坦(47%)联合降压治疗.两种治疗均具有同样良好的耐受性。参数研究（血管紧张素受体脑啡肽抑制剂与血管紧张素受体阻滞剂测量老年人动脉僵硬度的前瞻性比较），第一次,在收缩期高血压和动脉僵硬的老年患者中，沙库巴曲/缬沙坦与奥美沙坦相比，在降低临床和动态中心性主动脉和肱动脉压方面具有优势。
Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled
trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The
study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (<140/90). At week 12, sacubitril/valsartan reduced central aortic systolic pressure (primary assessment) greater than olmesartan by -3.7 mm Hg (P=0.010), further corroborated by secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P<0.012; mean 24-hour ambulatory brachial systolic blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P<0.001). Differences in 24-hour ambulatory pressures were pronounced during sleep. After 52 weeks, blood pressure parameters were similar between treatments (P<0.002); however, more patients required add-on antihypertensive therapy with olmesartan (47%) versus sacubitril/valsartan (32%; P<0.002). Both treatments were equally well tolerated. The PARAMETER
study (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Measuring Arterial Stiffness in the Elderly), for the first time, demonstrated superiority of sacubitril/valsartan versus olmesartan in reducing clinic and ambulatory central aortic and brachial pressures in elderly patients with systolic hypertension and stiff arteries.
