A total of 383 records were identified from the initial search, but 84 duplicate records were marked and then removed by software. After an initial evaluation, 14 studies were retained for further evaluation based on full texts. Finally, 9 RCTs [10, 13,14,15,16,17,18,19, 42] were included for the final analysis, because five studies were excluded due to unrelated to a specific topic (n = 2), conference abstract without sufficient data (n = 1), and ineligible controls (n = 2). We created Fig. 1 to depict the procedural steps of study selection.

PRISMA flow chart of study selection. (n, number of articles)

The baseline information of 9 included studies is summarized in Table 1. All studies were published between 2010 and 2022. The sample size of individual study ranged from 72 to 1435, with an accumulated number of 5474. Among 9 eligible studies, three studies were multiple-armed experiments and the others were two-armed experiments. Three administration doses were identified for sacubitril/valsartan in nine eligible studies, including 100, 200, and 400 mg admitted daily. All studies [10, 13,14,15,16,17,18,19, 42] reported mean blood pressure in sitting position, seven studies [10, 13, 16,17,18,19] reported mean ambulatory blood presume, and another eight [10, 15,16,17,18,19, 42] studies reported trial-specified AEs. The outcome data of all eligible studies are shown in Table 2. Network plots for mean blood pressure in the sitting position (i.e., 156, 1748, and 1264 patients were assigned to 100 m once daily, 200 mg once daily, and 400 mg once daily, respectively), mean ambulatory blood pressure (i.e., 156, 1361, and 786 patients were assigned to 100 once daily, 200 mg once daily, and 400 mg once daily, respectively), and trial-specified AEs (i.e., 156, 1269, and 1129 patients were assigned to 100 mg once daily, 200 mg once daily, 400 mg once daily, respectively) are shown in Fig. 2.

Network plot of all outcomes. The size of a circle is proportionate to the accumulated number of patients and the width of a solid line between two circles is proportional to the number of direct comparisons. AEs, adverse events

Among nine eligible studies, all studies [10, 13,14,15,16,17,18,19, 42] generated random sequence using appropriate methods and correctly concealed the allocation process. All studies [10, 13,14,15,16,17,18,19, 42] were rated as low risk in performance bias, but only three studies [10, 13, 17] clearly reported the methods of blinding outcome assessment. Moreover, three [10, 17, 42] and four [10, 13,14,15] studies were definitively identified to completely report outcome data and anticipated outcomes. Only one study [10] was definitively determined as low risk in other sources. The detailed risk of bias of all studies is shown in Fig. S1. Finally, the overall quality was appraised as a moderate level.

All studies [10, 13,14,15,16,17,18,19, 42] reported data of msSBP, and we did not detect substantial inconsistency based on the global inconsistency test (Fig. S2) and the node-split test (Fig. S3). Therefore, the consistency model was selected to calculate the pooled estimate. Network meta-analysis suggested that there was no statistical difference of sacubitril/valsartan 100 mg once daily vs. Valsartan 80 mg once daily, sacubitril/valsartan 200 mg once daily vs. Olmesartan 20 mg once daily and Valsartan 160 mg once daily, and sacubitril/valsartan 400 mg once daily vs. Olmesartan 40 mg once daily and Valsartan 320 mg once daily (Fig. S4). In addition, there was no significant difference in the reduction of msSBP between three doses of sacubitril/valsartan (Fig. S4). The numerical results can be accessed in Table 3. However, results of SUCRA analysis revealed that sacubitril/valsartan 200 mg once daily had the highest probability of being best (87.1%), followed by Olmesartan 20 mg once daily (78.6%), sacubitril/valsartan 400 mg once daily (49.5%), Valsartan 160 mg once daily (47.3%), Valsartan 40 mg once daily (44.5%), Valsartan 320 mg once daily (39.5%), 100 mg once daily (28.3%), and Valsartan 80 mg once daily (25.1%) (Fig. S4).

All studies [10, 13,14,15,16,17,18,19, 42] reported data of msDBP, but we detected substantial inconsistency based on the global inconsistency test (Fig. S2) and the node-split test (Fig. S3). Therefore, we selected the inconsistency model to calculate the pooled estimate. Network meta-analysis suggested that there was no statistical difference of sacubitril/valsartan 100 mg once daily vs. Valsartan 80 mg once daily, sacubitril/valsartan 200 mg once daily vs. Olmesartan 20 mg once daily and Valsartan 160 mg once daily, and sacubitril/valsartan 400 mg once daily vs. Olmesartan 40 mg once daily and Valsartan 320 mg once daily (Fig. S4). In addition, 400 mg once daily of sacubitril/valsartan was superior to 200 mg once daily in reducing msDBP (MD, − 9.38 mmHg; 95% CI, − 17.79 to − 0.97 mmHg), although the other two comparisons were not statistically significant (Fig. S4). The numerical results can be accessed in Table 3. Furthermore, results of SUCRA analysis revealed that Valsartan 160 mg once daily had the highest probability of being best (77.1%), followed by Valsartan 320 mg once daily (71.2%), 400 mg once daily of sacubitril/valsartan (66.2%), 100 mg once daily of sacubitril/valsartan (47.2%), Valsartan 80 mg once daily (42.3%), Olmesartan 20 mg once daily (18.0%), and 200 mg once daily of sacubitril/valsartan (16.8%) (Fig. S4).

Seven studies [10, 13, 16,17,18,19] reported data of 24-h maSBP, but we detected substantial inconsistency based on the global inconsistency test (Fig. S2) and the node-split test (Fig. S3). We, therefore, used an inconsistency model to calculate the pooled estimate. Network meta-analysis suggested that there was no statistical difference of 100 mg once daily of sacubitril/valsartan vs. Valsartan 80 mg once daily, 200 mg once daily of sacubitril/valsartan vs. Olmesartan 20 mg once daily, and 400 mg once daily of sacubitril/valsartan vs. Valsartan 320 mg once daily; however, 200 mg once daily of sacubitril/valsartan was inferior to Valsartan 160 mg once daily (Fig. S5). In addition, 200 mg once daily of sacubitril/valsartan was superior to 100 mg once daily in reducing 24-h maSBP (MD, -3.70 mmHg; 95% CI − 6.22 to − 1.18 mmHg), although the other two comparisons were not statistically significant (Fig. S5). The numerical results can be accessed in Table 3. Furthermore, results of SUCRA analysis revealed that 200 mg once daily of sacubitril/valsartan had the highest probability of being best (99.0%), followed by 400 mg once daily of sacubitril/valsartan (72.2%), Valsartan 320 mg once daily (68.3%), Valsartan 160 mg once daily (42.3%), 100 mg once daily of sacubitril/valsartan (31.3%), Olmesartan 20 mg once daily (18.6%), and Valsartan 80 mg once daily (18.3%) (Fig. S5).

These same studies [10, 13, 16,17,18,19] also reported data of 24-h maDBP and substantial inconsistency was detected by the global (Fig. S2) and local (Fig. S3) inconsistency tests. The inconsistency model was, therefore, selected to calculate the pooled estimate. Network meta-analysis suggested that there was no statistical difference of 100 mg once daily of sacubitril/valsartan vs. Valsartan 80 mg once daily, 200 mg once daily of sacubitril/valsartan vs. Olmesartan 20 mg once daily and Valsartan 160 mg once daily; however, 400 mg once daily of sacubitril/valsartan was better than Valsartan 320 mg once daily (Fig. S5). In addition, 200 mg once daily of sacubitril/valsartan was superior to 100 mg once daily (MD, − 2.98; 95% CI − 5.11 to − 0.85) and 400 mg once daily in reducing 24-h maDBP (MD, 1.31 mmHg; 95% CI 0.61–2.01 mmHg) (Fig. S5). The numerical results can be accessed in Table 3. Results of SUCRA analysis revealed that Valsartan 320 mg once daily had the highest probability of being best (94.5%), followed by 200 mg once daily of sacubitril/valsartan (84.4%), Valsartan 160 mg once daily (66.6%), 400 mg once daily of sacubitril/valsartan (46.0%), Valsartan 80 mg once daily (29.7%), Olmesartan 20 mg once daily (19.2%), and 100 mg once daily of sacubitril/valsartan (9.7%) (Fig. S5).

A total of eight studies [10, 15,16,17,