Effects of sacubitril/valsartan on ventricular remodeling in patients with hypertension and maintenance hemodialysis: a retrospective cohort study

Background Left ventricular hypertrophy (LVH), a hallmark of pathological ventricular remodeling, is highly prevalent and strongly predicts mortality in patients undergoing maintenance hemodialysis (MHD). This study aimed to compare the efficacy of sacubitril/valsartan (SV) vs. angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) on ventricular remodeling in hypertensive MHD patients. Methods In this single-center retrospective cohort study conducted between January 2023 and June 2025, 111 hypertensive patients undergoing MHD for at least 3 months were divided into SV ( n  = 46) and ACEi/ARB ( n  = 65) groups based on their antihypertensive regimen. The primary endpoint was the change in left ventricular mass index (LVMI) after 6 months. Secondary endpoints included changes in blood pressure, other echocardiographic parameters, NT-proBNP, and safety outcomes. Results The mean age was 56.17 ± 13.47 years and 68.5% were male. After 6 months, LVMI significantly decreased in the SV group (−5.52 g/m 2 , 95% CI −9.35 to −1.69, P  = 0.006) but not in the ACEi/ARB group (1.11 g/m 2 , 95% CI −3.27 to 5.50, P  = 0.615). Two-way repeated measures ANOVA revealed a significant group × time interaction for LVMI ( P  = 0.033). Both groups achieved significant blood pressure reductions: systolic blood pressure decreased by 9.81 mmHg ( P  < 0.001) in the ACEi/ARB group and by 10.46 mmHg ( P  < 0.001) in the SV group. New-onset intradialytic hypotension occurred in 7 (6.3%) patients and hyperkalemia in 9 (8.1%) patients, with similar incidences between groups and no treatment discontinuations. Conclusions Compared to ACEi/ARB, SV is more effective in reversing ventricular remodeling in hypertensive MHD patients.