Mitsuno Ryunosuke, Uchiyama Kiyotaka, Nakayama Takashin, Takahashi Rina, Yoshimoto Norifumi, Yamaguchi Shintaro, Washida Naoki, Kanda Takeshi, Hayashi Kaori, Itoh Hiroshi
Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Nephrology, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan.
J Hum Hypertens. 2023 Dec;37(12):1049-1055. doi: 10.1038/s41371-023-00851-9. Epub 2023 Jul 24.
Angiotensin receptor-neprilysin inhibitors (ARNIs) have been approved as antihypertensive agents in Japan, and thiazide diuretics (TZDs) are widely used concomitantly with renin-angiotensin system inhibitors (RASIs) for hypertension. This retrospective study included patients with hypertension who switched from RASI to ARNI therapy (ARNI group) and those who were prescribed TZDs with RASIs (TZD/RASI group). Drug-related changes in the estimated glomerular filtration rate (eGFR), blood pressure (BP), body weight (BW), serum electrolytes, uric acid (UA), and triglyceride levels were compared between the two groups. Overall, 70 participants (31 and 39 in the ARNI and TZD/RASI groups, respectively) were enrolled and observed for a median of 2 months. According to linear mixed models, compared with the TZD/RASI group, the ARNI group exhibited a significant change in mean eGFR of 3.71 mL/min/1.73 m [95% confidence interval (CI), 0.57-6.84; P = 0.02] from the time of switching drug to the next outpatient visit. Further, compared with the TZD/RASI group, the ARNI group exhibited significant changes in mean serum UA (-1.27; 95% CI, -1.66 to -0.88), sodium (1.22; 95% CI, 0.12 to -2.32), chloride (2.14; 95% CI, 0.75-3.52), and triglyceride (-52.1; 95% CI, -100.9 to -3.29) levels. Conversely, serum potassium levels, BW, and systolic and diastolic BP did not differ significantly between the two groups (P = 0.69, 0.44, 0.49, and 0.66, respectively). Compared with the combination therapy of TZD and RASI, ARNI therapy causes less renal dysfunction, hyperuricemia, and hypertriglyceridemia with fewer electrolyte abnormalities and no significant difference in antihypertensive effects.
血管紧张素受体脑啡肽酶抑制剂（ARNI）在日本已被批准作为抗高血压药物，噻嗪类利尿剂（TZD）与肾素 - 血管紧张素系统抑制剂（RASI）联合广泛用于治疗高血压。这项回顾性研究纳入了从RASI转换为ARNI治疗的高血压患者（ARNI组）以及接受RASI联合TZD治疗的患者（TZD/RASI组）。比较了两组患者估计肾小球滤过率（eGFR）、血压（BP）、体重（BW）、血清电解质、尿酸（UA）和甘油三酯水平与药物相关的变化。总体而言，共纳入70名参与者（ARNI组31名，TZD/RASI组39名），中位观察时间为2个月。根据线性混合模型，与TZD/RASI组相比，ARNI组从换药至下次门诊就诊时平均eGFR有显著变化，为3.71 mL/min/1.73 m²[95%置信区间（CI），0.57 - 6.84；P = 0.02]。此外，与TZD/RASI组相比，ARNI组的平均血清UA（-1.27；95%CI，-1.66至-0.88）、钠（1.22；95%CI，0.12至2.32）、氯（2.14；95%CI，0.75 - 3.52）和甘油三酯（-52.1；95%CI，-100.9至-3.29）水平有显著变化。相反，两组患者的血清钾水平、体重以及收缩压和舒张压无显著差异（P分别为0.69、0.44、0.49和0.66）。与TZD和RASI联合治疗相比，ARNI治疗导致的肾功能不全、高尿酸血症和高甘油三酯血症较少，电解质异常较少，且降压效果无显著差异。
