Sacubitril/Valsartan Delivers Safer, Stronger Blood Pressure Control in CKD: Study Finds
Japan: A recent study has revealed that replacing angiotensin II receptor blockers (ARBs) with sacubitril/valsartan can safely improve 24-hour blood pressure (BP) management in individuals with advanced chronic kidney disease (CKD). The findings, published in the American Journal of Hypertension, indicate that patients with non-dialysis CKD stages 4-5 who struggle to reach BP targets on ARBs may benefit from this therapeutic switch.
Chronic kidney disease is often associated with hypertension, which significantly contributes to disease progression and cardiovascular complications. Despite ARBs being a widely used antihypertensive option, many patients fail to achieve optimal BP control, necessitating alternative treatment strategies.
Against the above background, Hiromichi Wakui, Yokohama City University Graduate School of Medicine, Yokohama, Japan, and colleagues assessed the impact of sacubitril/valsartan, a first-of-its-kind angiotensin receptor neprilysin inhibitor (ARNI), on 24-hour blood pressure and its safety over a 12-weeks in Japanese patients with non-dialysis advanced chronic kidney disease.
For this purpose, the researchers conducted a prospective, single-arm exploratory study, enrolling patients with non-dialysis CKD stage G4-5 (eGFR <30 mL/min/1.73 m²) who failed to achieve BP targets with ARBs. These patients were switched to sacubitril/valsartan, and the study evaluated changes in 24-hour systolic BP (SBP) using ambulatory BP monitoring (ABPM) over 12 weeks. Safety outcomes, including a ≥30% rise in serum creatinine and incidence of hyperkalemia, were also assessed.
The study revealed the following findings:
- A total of 30 patients were enrolled, with 29 switching to sacubitril/valsartan.
- Efficacy analysis was conducted on 26 patients.
- The baseline mean eGFR was 21.1±5.0 mL/min/1.73m².
- Baseline office BP was 149.4±23.7/80.7±11.9 mmHg.
- Baseline 24-hour BP was 139.6±17.7/77.0±7.8 mmHg.
- Baseline daytime BP was 143.5±18.5/79.6±8.7 mmHg.
- Baseline nighttime BP was 131.0±20.4/71.1±8.8 mmHg.
- After 12 weeks, 24-hour SBP decreased by -7.1±12.4 mmHg.
- Daytime SBP reduced by -7.7±12.9 mmHg.
- Nighttime SBP showed a non-significant reduction of -5.8±15.8 mmHg.
- No cases of potassium levels exceeding 6.0 mmol/L were observed.
The researchers showed that switching from ARBs to sacubitril/valsartan provides a safe and effective strategy for enhancing 24-hour blood pressure control in patients with non-dialysis CKD stage G4-5 who fail to achieve target BP levels with ARBs. Based on this, they suggested that this approach may offer better hypertension management without compromising renal function or increasing the risk of hyperkalemia.
"Given the challenges of managing hypertension in CKD patients, these findings emphasize the importance of personalized treatment approaches. By integrating sacubitril/valsartan into clinical practice, healthcare providers may be able to enhance BP control in patients who do not achieve desired outcomes with ARBs alone," the authors concluded.
Reference:
Kinguchi, S., Ishiga, K., Wakui, H., Azushima, K., Kanaoka, T., Kobayashi, Y., Haze, T., Hirawa, N., & Tamura, K. Switching from ARBs to sacubitril/valsartan safely improves 24-hour ambulatory blood pressure in patients with advanced chronic kidney disease. American Journal of Hypertension. https://doi.org/10.1093/ajh/hpaf028
