Prescription patterns of sacubitril/valsartan among patients with hypertension in Japan.

Background: Sacubitril/valsartan (S/V) is an established therapy for heart failure that has been recently approved for hypertension in Japan. However, evidence regarding its use in combination with other antihypertensive agents in real-world practice is limited. Objective: To describe real-world prescribing patterns of S/V among patients with hypertension in Japan. Methods: A retrospective cohort study using a nationwide Japanese electronic health record database (August 2020 to October 2023) identified adults with hypertension (ICD-10: I10-I15) who were newly prescribed S/V. Patients with heart failure were excluded. Concomitant antihypertensive medications, S/V dosing, and discontinuation patterns were assessed over 90 days following initiation. Results: Of the 9,486 patients (median age 79 years; 50.6% men), 63.6% received S/V with a calcium channel blocker (CCB), 22.5% as monotherapy, and 11.8% as triple therapy with CCB and thiazide. At day 90, 55.5% of patients received S/V plus a CCB, and 26.0% were on S/V monotherapy. The S/V discontinuation rate reached 11.8% by day 90. Approximately half of those on triple therapy discontinued the thiazide diuretic within 30 days. Conclusions: In Japanese patients with hypertension, S/V is most commonly used in combination with a CCB, although a notable proportion receive it as monotherapy. These findings highlight the need for further studies to evaluate the safety, efficacy, and cost-effectiveness of S/V-based combination regimens.