Kidney Week

Abstract: SA-PO352

Comparison between Sacubitril-Valsartan and Thiazide Diuretics among Patients with Uncontrolled Hypertension in Japan

Session Information

• Hypertension, CVD, and the Kidneys: Clinical Research
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Kobayashi, Kazuo, Committee of Hypertension and Kidney Disease, Kanagawa Physicians Association, Yokohama, Japan

Kazuo Kobayashi, DrMed, PhD

• Sotozawa, Mari, Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Mari Sotozawa, MD

• Chiba, Kyoji, Department of Nephrology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan

Kyoji Chiba, MD

• Wakui, Hiromichi, Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Hiromichi Wakui, MD, PhD

• Tamura, Kouichi, Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

Kouichi Tamura, MD, DrMed, PhD

Background

The hypertension paradox is an urgent issue in clinical practice. Although ARBs and calcium channel blockers (CCBs) were widely used, less than 10% of patients used thiazide diuretics in Japan. Sacubitril valsartan can be used for not only patients with heart failure but also with hypertension. This study aimed to evaluate the differences of an efficacy and safety between sacubitril valsartan and thiazide diuretics in patients with poorly BP control.

Methods

Patients who showed ≥130/80 mmHg in the office despite a combination treatment of RAS inhibitors and CCBs were included. The comparison between patients treated with the addition of thiazide diuretics (THZ group, n=267) and those transferred from RAS inhibitors to sacubitril valsartan (SacVal group, n=381) was analyzed. A general linear mixed model (GLMM) was used for the analysis of clinical findings at baseline, 4 months, and 12 months. The rate of discontinuation was analyzed using the Cox proportional hazard model.

Results

The baseline backgrounds of the THZ /SacVal group were as follows; female 39/35 (%), mean age, body weight (BW), and eGFR at baseline were 67.8 ± 13.1/72.3±12.6 (years) (p<0.001), 68.1±15.7/66.2±14.2(kg), 61.2±20.9/56.8±20.3 (ml/min/1.73 m²) (p=0.01), respectively.
In the GLMM analysis, significant decrease in office and home BP after treatment was observed in both groups (p<0.001), however, no significant interaction effects between the type of drug and time course were observed for BP. Significant interaction effects were observed for eGFR, uric acid (UA), logarithmic value of ACR (LnACR), BW, and hemoglobin A_1c (HbA_1c) (all p<0.001).
eGFR, UA, and LnACR were significantly decreased (p<0.001), increased (p<0.001), and decreased (p<0.001), respectively, in the THZ group during the time course. Significant decreases were observed in BW and HbA_1c in the SacVal group (p<0.001). Treatment discontinuation due to adverse effects was significantly more frequent in 34 cases (13%) in the THZ group, than 12 cases (3%) in the SacVal group with hazard ratio of 6.3 [95% CI, 2.7, 14.9] (p<0.001).

Conclusion

Both treatments decreased BP; however, compared to thiazide, sacubitril valsartan resulted in a superior reduction in BW, HbA_1c, and favorable changes in kidney function, with better treatment adherence.