{"title":"苏比里尔/缬沙坦对日本血压控制不佳的糖尿病患者影响的回顾性分析","authors":"Shun Ito, Kazuo Kobayashi, Mari Sotozawa, Kyoji Chiba, Keiichi Chin, Hideo Shimura, Toshinao Tsuge, Hiroyuki Sakai, Takayuki Furuki, Atsushi Matsuzaki, Shinichi Nakajima, Nobukazu Takada, Hareaki Yamamoto, Hiroshi Takeda, Hiromichi Wakui, Takamasa Iwasawa, Togo Aoyama, Kouichi Tamura, Masao Toyoda, Akira Kanamori","doi":"10.1111/jdi.70126","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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, <i>n</i> = 136) and those switching to sacubitril/valsartan (SacVal group, <i>n</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 (<i>P</i> < 0.001), improved glycated hemoglobin A<sub>1c</sub> (<i>P</i> = 0.02), and a smaller estimated glomerular filtration rate decline (<i>P</i> = 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, <i>P</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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<sub>1c</sub>, and estimated glomerular filtration rate, along with a significantly better treatment tolerability.</p>\n </section>\n </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"16 10","pages":"1859-1869"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70126","citationCount":"0","resultStr":"{\"title\":\"Retrospective analysis of influences of sacubitril/valsartan in patients with diabetes with poorly controlled blood pressure in Japan\",\"authors\":\"Shun Ito, Kazuo Kobayashi, Mari Sotozawa, Kyoji Chiba, Keiichi Chin, Hideo Shimura, Toshinao Tsuge, Hiroyuki Sakai, Takayuki Furuki, Atsushi Matsuzaki, Shinichi Nakajima, Nobukazu Takada, Hareaki Yamamoto, Hiroshi Takeda, Hiromichi Wakui, Takamasa Iwasawa, Togo Aoyama, Kouichi Tamura, Masao Toyoda, Akira Kanamori\",\"doi\":\"10.1111/jdi.70126\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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, <i>n</i> = 136) and those switching to sacubitril/valsartan (SacVal group, <i>n</i> = 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 (<i>P</i> < 0.001), improved glycated hemoglobin A<sub>1c</sub> (<i>P</i> = 0.02), and a smaller estimated glomerular filtration rate decline (<i>P</i> = 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, <i>P</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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<sub>1c</sub>, and estimated glomerular filtration rate, along with a significantly better treatment tolerability.</p>\\n </section>\\n </div>\",\"PeriodicalId\":51250,\"journal\":{\"name\":\"Journal of Diabetes Investigation\",\"volume\":\"16 10\",\"pages\":\"1859-1869\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.70126\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Diabetes Investigation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jdi.70126\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Diabetes Investigation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jdi.70126","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
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 A1c (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 A1c, and estimated glomerular filtration rate, along with a significantly better treatment tolerability.
期刊介绍：
Journal of Diabetes Investigation is your core diabetes journal from Asia; the official journal of the Asian Association for the Study of Diabetes (AASD). The journal publishes original research, country reports, commentaries, reviews, mini-reviews, case reports, letters, as well as editorials and news. Embracing clinical and experimental research in diabetes and related areas, the Journal of Diabetes Investigation includes aspects of prevention, treatment, as well as molecular aspects and pathophysiology. Translational research focused on the exchange of ideas between clinicians and researchers is also welcome. Journal of Diabetes Investigation is indexed by Science Citation Index Expanded (SCIE).
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