Six-month renal marker trajectories with azilsartan–indapamide versus azilsartan–nitrendipine in essential hypertension: a pragmatic comparative study

Abstract Renal preservation is a key objective in the management of essential hypertension. Azilsartan is a potent angiotensin receptor blocker, but whether the choice of add-on therapy influences short-term renal marker trajectories under azilsartan-based regimens remains uncertain. Methods We conducted a 6-month comparative analysis of two azilsartan-based regimens in patients with essential hypertension: Azilsartan + indapamide (A+I) Azilsartan + nitrendipine (A+N) Renal endpoints included estimated glomerular filtration rate (eGFR, CKD-EPI) and microalbuminuria (MAU), assessed at baseline and 6 months. Within-group changes were evaluated using paired tests. Between-group differences were assessed using change-from-baseline analysis and ANCOVA models adjusted for baseline renal values. Results Complete paired renal data were available for 103 patients (A+I n=51; A+N n=52). Both regimens were associated with significant improvement in eGFR: A+I: 83.2±18.8 to 89.5±17.8 ml/min (Δ+6.33; p=0.0108) A+N: 81.6±21.8 to 86.8±20.0 ml/min (Δ+5.21; p=0.0205) Between-group difference in ΔeGFR was not significant (p=0.731). Baseline-adjusted eGFR at 6 months was similar (A+N vs A+I −1.73 ml/min; 95% CI −7.36 to 3.90; p=0.544). MAU decreased in both groups. The between-group difference in raw change was not statistically significant (p=0.307). In a baseline-adjusted log-scale model, A+N demonstrated lower 6-month MAU (β=−0.267; 95% CI −0.509 to −0.026; p=0.030), interpreted as exploratory. Conclusion In this pragmatic comparative cohort, azilsartan combined with either indapamide or nitrendipine demonstrated similar short-term improvements in eGFR and reductions in microalbuminuria. The choice of add-on agent did not meaningfully alter short-term renal trajectory under azilsartan-based therapy.