Key result
Replacing ARBs with sacubitril/valsartan is linked to a ~7 mmHg 24-hour SBP reduction in advanced CKD.
Why the study?
The effects of sacubitril/valsartan on 24-hour blood pressure and safety in patients with non-dialysis advanced CKD required investigation.
Does switching from ARBs to sacubitril/valsartan improve 24-hour ambulatory blood pressure in patients with advanced non-dialysis CKD?
Does switching from ARBs to sacubitril/valsartan improve 24-hour ambulatory blood pressure in patients with advanced non-dialysis CKD?
Mean Difference: -7.1
p-value: p=< 0.01
Switching from ARBs to sacubitril/valsartan significantly reduced 24-hour systolic blood pressure without worsening renal function or causing severe hyperkalemia in patients with advanced CKD.
May support sacubitril/valsartan for BP control in advanced non-dialysis CKD; hypothesis-generating and requires randomized confirmation.
BACKGROUND: We investigated the effects of sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), on 24-hour blood pressure (BP) and safety for 12 weeks in Japanese patients with non-dialysis advanced chronic kidney disease (CKD). METHODS: We conducted a prospective, single-arm exploratory study. Patients with non-dialysis CKD stage G4-5 (estimated glomerular filtration (eGFR) <30 mL/min/1.73 m2) who did not achieve their BP goals with angiotensin receptor blocker (ARB) administration, were enrolled and switched to sacubitril/valsartan. Primary and key secondary endpoints were changes from baseline in the 24-hour systolic BP (SBP) measured via ambulatory BP monitoring (ABPM) over 12 weeks and the safety, especially incidence of serum creatinine (Cr) increase (≥ 30% increase from baseline) and hyperkalemia. RESULTS: Thirty patients were enrolled, and 29 patients were switched to sacubitril/valsartan. Efficacy analysis was conducted on 26 patients. Baseline mean eGFR and office BP were 21.1 ± 5.0 mL/min/1.73m2 and 149.4 ± 23.7/80.7 ± 11.9 mmHg, respectively. Baseline 24-hour, daytime, and nighttime BP were 139.6 ± 17.7/77.0 ± 7.8 mmHg, 143.5 ± 18.5/79.6 ± 8.7 mmHg, and 131.0 ± 20.4/71.1 ± 8.8 mmHg, respectively. After 12 weeks, changes in 24-hour, daytime, and nighttime SBP from baseline were -7.1 ± 12.4 mmHg (P < 0.01), -7.7 ± 12.9 mmHg (P < 0.01), and -5.8 ± 15.8 mmHg (P = 0.07), respectively. No incidences of potassium values > 6.0 mmol/L or serum Cr ≥ 30% increase from baseline were reported after sacubitril/valsartan initiation. CONCLUSIONS: Switching from ARB to sacubitril/valsartan can safely enhance 24-hour antihypertensive treatment in patients with non-dialysis CKD G4-5 who do not achieve BP goals with ARBs. CLINICAL TRIALS REGISTRATION: Trial Number jRCT1031220149. CLINICAL TRIALS REGISTRATION: Trial Number jRCT1031220149.
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Kinguchi et al. (2025) studied non-dialysis advanced chronic kidney disease (CKD) (n=30). sacubitril/valsartan vs. ARB (baseline) was evaluated on changes from baseline in the 24-hour systolic BP (SBP) measured via ambulatory BP monitoring (ABPM) over 12 weeks (MD -7.1 mmHg, p=< 0.01). Switching from ARBs to sacubitril/valsartan in patients with advanced CKD significantly reduced 24-hour systolic blood pressure by 7.1 mmHg from baseline (P < 0.01).