Sacubitril/Valsartan Offers Promise, But Risks, for Resistant Hypertension

In November 2025, at the American Heart Association Scientific Sessions in New Orleans, researchers presented findings from a real-world study on the use of sacubitril/valsartan in treating resistant hypertension. The retrospective study, which tracked over 2,000 adults across the US, Middle East, and Europe, revealed that the proportion of patients achieving target blood pressure levels steadily increased over the one-year follow-up, reaching up to 77%.

However, the study also uncovered significant and growing rates of adverse events, including acute kidney injury, electrolyte disturbances, and all-cause hospitalizations. Key opinion leaders emphasized that "close monitoring is critical, as not all patients will tolerate the risks" associated with sacubitril/valsartan.

These findings underscore the dual-edged nature of sacubitril/valsartan in resistant hypertension. While the treatment shows promise in improving blood pressure control, the safety concerns highlighted in the real-world data suggest the need for careful patient selection and frequent monitoring to strike the right balance between antihypertensive benefit and risk. Going forward, the use of sacubitril/valsartan in this complex, high-risk patient population will likely depend on strategies that integrate close monitoring and multidisciplinary care, as well as the development of agents with more favorable safety profiles.