Ito Shun, Kobayashi Kazuo, Sotozawa Mari, Chiba Kyoji, Chin Keiichi, Shimura Hideo, Tsuge Toshinao, Sakai Hiroyuki, Furuki Takayuki, Matsuzaki Atsushi, Nakajima Shinichi, Takada Nobukazu, Yamamoto Hareaki, Takeda Hiroshi, Wakui Hiromichi, Iwasawa Takamasa, Aoyama Togo, Tamura Kouichi, Toyoda Masao, Kanamori Akira
Committee of Hypertension and Kidney Disease, Kanagawa Physicians Association, Yokohama, Kanagawa Prefecture, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa Prefecture, Japan.
J Diabetes Investig. 2025 Jul 18. doi: 10.1111/jdi.70126.
Achieving optimal blood pressure control remains challenging, particularly for patients with diabetes. This post-hoc study compared the efficacy and safety of switching to sacubitril/valsartan vs adding thiazide diuretics in this population.
This retrospective study included patients with diabetes and inadequate blood pressure control in the office or home settings despite combination therapy with renin-angiotensin system inhibitors and calcium channel blockers. Patients were categorized into those receiving an additional thiazide diuretic (THZ group, n = 136) and those switching to sacubitril/valsartan (SacVal group, n = 199). The treatment effects over 12 months were analyzed using propensity score analysis with inverse probability weighting. Treatment discontinuation rates were assessed using the Cox proportional hazards model.
In the propensity score analysis model, target pressure achievement rates were similar between the two groups. However, compared to the THZ group, the SacVal group exhibited significantly lower uric acid levels (P < 0.001), improved glycated hemoglobin A (P = 0.02), and a smaller estimated glomerular filtration rate decline (P = 0.02). Treatment discontinuation due to adverse events was significantly higher in the THZ group (13% vs 1%), with a hazard ratio of 11.53 (95% confidence interval: 2.66-49.93, P < 0.001).
The combination of sacubitril/valsartan with calcium channel blockers provided a similar reduction in blood pressure compared with thiazide with renin-angiotensin system inhibitors and calcium channel blockers, and reported more favorable changes in uric acid levels, glycated hemoglobin A, and estimated glomerular filtration rate, along with a significantly better treatment tolerability.
实现最佳血压控制仍具有挑战性，尤其是对于糖尿病患者。这项事后分析研究比较了在该人群中换用沙库巴曲缬沙坦与加用噻嗪类利尿剂的疗效和安全性。
这项回顾性研究纳入了尽管联合使用肾素-血管紧张素系统抑制剂和钙通道阻滞剂但在诊室或家庭环境中血压控制不佳的糖尿病患者。患者被分为接受额外噻嗪类利尿剂治疗的患者（噻嗪组，n = 136）和换用沙库巴曲缬沙坦的患者（沙库巴曲缬沙坦组，n = 199）。使用倾向评分分析和逆概率加权法分析12个月内的治疗效果。使用Cox比例风险模型评估治疗中断率。
在倾向评分分析模型中，两组的目标血压达标率相似。然而，与噻嗪组相比，沙库巴曲缬沙坦组的尿酸水平显著降低（P < 0.001），糖化血红蛋白改善（P = 0.02），估计肾小球滤过率下降幅度较小（P = 0.02）。噻嗪组因不良事件导致的治疗中断率显著更高（13% 对1%），风险比为11.53（95%置信区间：2.66 - 49.93，P < 0.001）。
与噻嗪类利尿剂联合肾素-血管紧张素系统抑制剂和钙通道阻滞剂相比，沙库巴曲缬沙坦与钙通道阻滞剂联合使用在降低血压方面效果相似，且在尿酸水平、糖化血红蛋白和估计肾小球滤过率方面有更有利的变化，同时治疗耐受性明显更好。
