Scholarlink

Background <p>Sacubitril/valsartan is typically prescribed for patients with heart failure and hypertension. We previously reported that sacubitril/valsartan provides comparable blood pressure (BP) reduction and superior tolerability compared to thiazide diuretics. This post hoc study aimed to compare the effects of sacubitril/valsartan and thiazide diuretics in patients with chronic kidney disease (CKD).</p> Methods <p>Among patients with poorly controlled BP in the office or at home despite combination therapy with renin–angiotensin system (RAS) inhibitors and calcium channel blockers, 611 patients were included: those treated with thiazide diuretics (THZ group) and those who were switched from RAS inhibitors to sacubitril/valsartan for the next 12 months. After implementing multiple methods, 505 patients with CKD (<i>n</i> = 211 in the THZ group and <i>n</i> = 294 in the SacVal group) were analyzed using propensity score analysis with inverse probability weighting.</p> Result <p>Compared to the THZ group, the SacVal group demonstrated significantly reduced systolic office BP, uric acid, and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) with mean difference (95% confidence interval [CI]) of -3.9 mmHg (−6.9, −0.9) (<i>p</i> = 0.01), −0.7 mg/dl (−1.1, −0.4) (<i>p</i> &lt; 0.001), and −2.9 mmol/mol (−5.7, −0.7) (<i>p</i> = 0.01), respectively. The annual decline in the estimated glomerular filtration rate (eGFR) was less in the SacVal group than in the THZ group, with a mean difference (95%CI) of 3.2 (1.3, 5.0) (<i>p</i> &lt; 0.001).</p> Conclusion <p>Compared to the addition of thiazide diuretics, the transition to sacubitril/valsartan resulted in greater BP reduction and more favorable changes in uric acid, HbA<sub>1c</sub>, and eGFR in patients with CKD.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Comparison of renal effects between sacubitril/valsartan and thiazide diuretics among patients with uncontrolled hypertension and chronic kidney disease in Japan

  • 期刊论文

  • 发表日期：

    2025年9月8日

查看全文
  • Mari Sotozawa,
  • Kyoji Chiba,
  • Kazuo Kobayashi,
  • Keiichi Chin,
  • Hideo Shimura,
  • Toshinao Tsuge,
  • Shun Ito,
  • Hiroyuki Sakai,
  • Takayuki Furuki,
  • Atsushi Matsuzaki,
  • Shinichi Nakajima,
  • Nobukazu Takada,
  • Hareaki Yamamoto,
  • Hiroshi Takeda,
  • Takamasa Iwasawa,
  • Togo Aoyama,
  • Masao Toyoda,
  • Akira Kanamori,
  • Hiromichi Wakui,
  • Kouichi Tamura

摘要

Background

Sacubitril/valsartan is typically prescribed for patients with heart failure and hypertension. We previously reported that sacubitril/valsartan provides comparable blood pressure (BP) reduction and superior tolerability compared to thiazide diuretics. This post hoc study aimed to compare the effects of sacubitril/valsartan and thiazide diuretics in patients with chronic kidney disease (CKD).

Methods

Among patients with poorly controlled BP in the office or at home despite combination therapy with renin–angiotensin system (RAS) inhibitors and calcium channel blockers, 611 patients were included: those treated with thiazide diuretics (THZ group) and those who were switched from RAS inhibitors to sacubitril/valsartan for the next 12 months. After implementing multiple methods, 505 patients with CKD (n = 211 in the THZ group and n = 294 in the SacVal group) were analyzed using propensity score analysis with inverse probability weighting.

Result

Compared to the THZ group, the SacVal group demonstrated significantly reduced systolic office BP, uric acid, and glycated hemoglobin A1c (HbA1c) with mean difference (95% confidence interval [CI]) of -3.9 mmHg (−6.9, −0.9) (p = 0.01), −0.7 mg/dl (−1.1, −0.4) (p < 0.001), and −2.9 mmol/mol (−5.7, −0.7) (p = 0.01), respectively. The annual decline in the estimated glomerular filtration rate (eGFR) was less in the SacVal group than in the THZ group, with a mean difference (95%CI) of 3.2 (1.3, 5.0) (p < 0.001).

Conclusion

Compared to the addition of thiazide diuretics, the transition to sacubitril/valsartan resulted in greater BP reduction and more favorable changes in uric acid, HbA1c, and eGFR in patients with CKD.