Li Lin, Weijing Bian, Qun Luo, Liang Wang, Na Liu, Min Yang, Jun Cen, Kedan Cai, Jia Hua, Hongwei Gu, Hualin Qi, Zhihong Wang, Jianying Niu, Yu Chen, Yizheng Gu, Chun Hu, Suhua Li, Yan Li, Nan Chen, Xiao Li
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引用次数: 0
Abstract
Introduction: Individuals with end-stage kidney disease frequently grapple with uncontrolled hypertension, which elevates their risk for cardiovascular complications.
Methods: This randomized, controlled, multicenter study, conducted across 10 hospitals, aimed to compare the effectiveness and safety of sacubitril-valsartan versus irbesartan in managing hypertension among dialysis patients. The primary efficacy variable of the present study was the reduction in office blood pressure (BP) after 12 months of treatment. Participants were randomly allocated to receive either sacubitril-valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) or irbesartan (angiotensin receptor blocker [ARB]) treatment over a 12-month period. We gauged treatment efficacy through office and 24-h ambulatory BP readings, as well as serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP). Safety outcomes were also evaluated.
Results: Baseline office BP averaged 150/82 mm Hg and median NT-proBNP was 6,336 pg/mL. In the intention-to-treat analysis, office systolic BP reduction was significantly greater in the ARNI than ARB group (-10.4 vs. -4.6 mm Hg, p = 0.003) after adjustment for baseline BP. In hemodialysis (HD) patients, the mean systolic/diastolic BP reduction was also greater in the ARNI than ARB group (-15.9/2.4 vs. -6.6/1.1 mm Hg, p < 0.05). While for peritoneal dialysis (PD) patients, there were no significant between-group differences (p = 0.087). Per-protocol analyses in 215 patients on office BP and 137 patients on 24-h BP produced similar results. During the study period, there was no between-group difference in the overall incidence of fatal and nonfatal events and hyperkalemia.
Conclusion: In dialysis patients with hypertension, especially those undergoing HD, ARNI demonstrated superior effectiveness in reducing BP compared to ARB. The safety profiles of both treatments were comparable and acceptable.
终末期肾病患者经常与不受控制的高血压作斗争,这增加了他们发生心血管并发症的风险。方法:这项随机、对照、多中心的研究,在10家医院进行,旨在比较苏比替-缬沙坦与厄贝沙坦治疗透析患者高血压的有效性和安全性。本研究的主要疗效变量是治疗12个月后办公室血压(BP)的降低。在12个月的时间里,参与者被随机分配接受苏比替-缬沙坦(血管紧张素受体-奈普利素抑制剂[ARNI])或厄贝沙坦(血管紧张素受体阻滞剂[ARB])治疗。我们通过办公室和24小时动态血压读数以及n端脑利钠肽前体(NT-proBNP)的血清浓度来衡量治疗效果。安全性结果也进行了评估。结果:基线办公室血压平均为150/82 mm Hg, NT-proBNP中位数为6336 pg/mL。在意向治疗分析中,基线血压调整后,ARNI组的办公室收缩压降低明显大于ARB组(-10.4 vs -4.6 mm Hg, p = 0.003)。在血液透析(HD)患者中,ARNI组的平均收缩压/舒张压降低也高于ARB组(-15.9/2.4 vs -6.6/1.1 mm Hg, p < 0.05)。而对于腹膜透析(PD)患者,组间差异无统计学意义(p = 0.087)。按方案分析215例办公室血压和137例24小时血压的结果相似。在研究期间,在致死性和非致死性事件以及高钾血症的总体发生率方面,组间没有差异。结论:在高血压透析患者中,尤其是HD患者,ARNI在降低血压方面比ARB更有效。两种治疗的安全性具有可比性和可接受性。
期刊介绍:
''Kidney Diseases'' aims to provide a platform for Asian and Western research to further and support communication and exchange of knowledge. Review articles cover the most recent clinical and basic science relevant to the entire field of nephrological disorders, including glomerular diseases, acute and chronic kidney injury, tubulo-interstitial disease, hypertension and metabolism-related disorders, end-stage renal disease, and genetic kidney disease. Special articles are prepared by two authors, one from East and one from West, which compare genetics, epidemiology, diagnosis methods, and treatment options of a disease.