Retrospective analysis of influences of sacubitril/valsartan in patients with diabetes with poorly controlled blood pressure in Japan

Aims 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. Methods 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. Results 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 1c ( 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). Conclusions 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 1c , and estimated glomerular filtration rate, along with a significantly better treatment tolerability.