Effects of Sacubitril/Valsartan on Blood Pressure and Proteinuria in Hypertensive Patients With Chronic Kidney Disease

The effects of the angiotensin receptor–neprilysin inhibitor sacubitril/valsartan (Sac/Val) on blood pressure (BP) and proteinuria in patients with advanced chronic kidney disease and hypertension remain unclear. This retrospective study evaluated the effect of Sac/Val on BP, the urinary protein-to-creatinine ratio (UPCR), and the estimated glomerular filtration rate (eGFR) in 66 patients with hypertension and proteinuria (UPCR ≥ 0.15 g/g) who received renin–angiotensin system inhibitors at 1, 3, and 6 months. At baseline, the median eGFR and UPCR were 28.4 mL/min/1.73 m² and 1.18 g/g, respectively. Significant reductions in systolic and diastolic BP, the eGFR, and the UPCR were observed over time (p values ranged from 0.03 to < 0.0001). At 1 month, 59% of patients showed a transient increase in the UPCR, and 21% had a ≥10% decline in the eGFR, with both metrics returning closer to baseline by 6 months. The percent change in the UPCR at 1 month was positively correlated with the percent change in the eGFR (r = 0.55, p < 0.0001). In conclusion, Sac/Val showed considerable BP-lowering efficacy even in patients with impaired renal function and proteinuria. Early changes in the eGFR were positively correlated with changes in the UPCR, and patients with an early decline in the eGFR or an increase in proteinuria did not experience further worsening.