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

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.