沙库巴曲缬沙坦对原发性高血压患者肾功能的影响

谢雅君; 赵蓓; 冯雪瑶; 李世兴; 李晓晔; 史宁

doi:10.6039/j.issn.1001-0408.2024.14.17

您当前的位置：

首页 >

文章列表页 >

沙库巴曲缬沙坦对原发性高血压患者肾功能的影响

药物与临床 | 更新时间：2024-07-25

- 沙库巴曲缬沙坦对原发性高血压患者肾功能的影响
- Effects of sacubitril/valsartan on renal function in patients with primary hypertension
- 中国药房 2024年35卷第14期页码：1770-1775
- 作者机构：
  
  1.战略支援部队特色医学中心药剂科，北京　100101
  2.战略支援部队特色医学中心心内科，北京　100101
  3.解放军总医院心血管病医学部派驻第一医学中心心内科，北京　100853
- 作者简介：
  
  主管药师。研究方向：临床药学。E-mail：xieyajun306@163.com
  副主任药师，硕士。研究方向：药事管理与临床药学。E-mail：shiningbeijing@126.com
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.14.17
  中图分类号： R972
- 纸质出版日期：2024-07-30，
  
  收稿日期：2023-12-25，
  
  修回日期：2024-04-21，
- 稿件说明：
扫描看全文
谢雅君,赵蓓,冯雪瑶等.沙库巴曲缬沙坦对原发性高血压患者肾功能的影响[J].中国药房,2024,35(14):1770-1775.

XIE Yajun,ZHAO Bei,FENG Xueyao,et al.Effects of sacubitril/valsartan on renal function in patients with primary hypertension[J].ZHONGGUO YAOFANG,2024,35(14):1770-1775.
谢雅君,赵蓓,冯雪瑶等.沙库巴曲缬沙坦对原发性高血压患者肾功能的影响[J].中国药房,2024,35(14):1770-1775. DOI： 10.6039/j.issn.1001-0408.2024.14.17.

XIE Yajun,ZHAO Bei,FENG Xueyao,et al.Effects of sacubitril/valsartan on renal function in patients with primary hypertension[J].ZHONGGUO YAOFANG,2024,35(14):1770-1775. DOI： 10.6039/j.issn.1001-0408.2024.14.17.

摘要

目的

探讨沙库巴曲缬沙坦对原发性高血压患者肾功能的影响。

方法

回顾性纳入2018年1月至2023年6月战略支援部队特色医学中心收治的原发性高血压患者，根据用药情况分为沙库巴曲缬沙坦组和缬沙坦组，采用倾向性评分匹配方法来均衡两组患者的一般资料数据。两组均在改善患者生活方式的基础上联合降压药物治疗；沙库巴曲缬沙坦组患者加用沙库巴曲缬沙坦片200 mg，口服，每日1次；缬沙坦组患者加用缬沙坦胶囊80 mg，口服，每日1次。比较两组患者治疗后2个月、治疗后6个月血肌酐水平较基线升高（以下简称“血肌酐升高”）幅度、血肌酐升高＞30%～50%或＞50%的患者比例、高钾血症（血钾≥5.5 mmol/L）患者比例，以及治疗前（基线水平）、治疗后2个月、治疗后6个月3个时间点患者的血肌酐水平、血钾水平及估算肾小球滤过率（eGFR）变化趋势。

结果

倾向性评分匹配后，沙库巴曲缬沙坦组62例患者，缬沙坦组61例患者，两组患者治疗前的一般资料比较，差异均无统计学意义（

＞0.05），具有可比性。治疗后6个月，沙库巴曲缬沙坦组患者血肌酐升高幅度显著低于缬沙坦组（

＝0.003）；沙库巴曲缬沙坦组患者血肌酐升高＞30%～50%的患者比例显著低于缬沙坦组（

＝0.045）。治疗后2个月和治疗后6个月，两组患者均未出现高钾血症事件。重复测量方差分析显示，治疗后6个月内，两组患者血肌酐、eGFR的变化趋势差异有统计学意义（

＜0.001）；服用缬沙坦的患者血肌酐持续上升，eGFR持续下降，而随着治疗时间的延长，服用沙库巴曲缬沙坦的患者血肌酐水平先升高后下降，eGFR先下降后升高。

结论

原发性高血压患者服用沙库巴曲缬沙坦可延缓甚至逆转肾功能水平的下降，对肾功能恶化具有限制作用，且不增加高钾血症的发生风险。

Abstract

OBJECTIVE

To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension.

METHODS

A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment.

RESULTS

After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （

＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （

＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （

＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （

＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication.

CONCLUSIONS

Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia.

关键词

沙库巴曲缬沙坦原发性高血压肾功能血肌酐血钾估算肾小球滤过率

Keywords

primary hypertensionrenal functionserum creatinineserum potassiumeGFR

references

WANG Z，CHEN Z，ZHANG L，et al. Status of hypertension in China：results from the China hypertension survey，2012-2015[J]. Circulation，2018，137（22）：2344-2356.

张梅，吴静，张笑，等.2018年中国成年居民高血压患病与控制状况研究[J].中华流行病学杂志，2021，42（10）：1780-1789.

ZHANG M，WU J，ZHANG X，et al. Prevalence and control of hypertension in adults in China，2018[J]. Zhonghua Liu Xing Bing Xue Za Zhi，2021，42（10）：1780-1789.

DOYLE A E. Hypertension and vascular disease[J]. Am J Hypertens，1991，4（2）：103-106.

POULTER N，MARMOT M G. Hypertension and the probability of an incapacitating event over a defined period：impact of treatment[J]. Eur Heart J，1992，13（Suppl. H）：39-44.

CHEN J S，PEI Y，WANG Q Y，et al. Effect of sacubitril/valsartan or valsartan on ventricular remodeling and myocardial fibrosis in perimenopausal women with hypertension[J]. J Hypertens，2023，41（7）：1077-1083.

YANG S，ZHANG H Z，YANG P P，et al. Efficacy and safety of LCZ696 for short-term management of essential hypertension compared with ARBs：a meta-analysis of rando-mized controlled trials[J]. J Cardiovasc Pharmacol，2021，77（5）：650-659.

MALIK A H，ARONOW W S. Efficacy of sacubitril/valsartan in hypertension[J]. Am J Ther，2022，29（3）：e322-e333.

HUBERS S A，BROWN N J. Combined angiotensin receptor antagonism and neprilysin inhibition[J]. Circulation，2016，133（11）：1115-1124.

MCDONAGH T A，METRA M，ADAMO M，et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. G Ital Cardiol，2024，25（3）：202-213.

HEIDENREICH P A，BOZKURT B，AGUILAR D，et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure：a report of the American College of Cardiolo-gy/American Heart Association Joint Committee on clinical practice guidelines[J]. J Am Coll Cardiol，2022，79（17）：e263-e421.

ZUO C C，LI X Y，FAN L L，et al. Effectiveness and safety of sacubitril/valsartan for patients with hypertension and heart failure in the real-world setting：a retrospective study in China[J]. J Clin Pharm Ther，2022，47（10）：1539-1547.

LEDWIDGE M，DODD J D，RYAN F，et al. Effect of sacubitril/valsartan vs valsartan on left atrial volume in patients with pre-heart failure with preserved ejection fraction：the PARABLE randomized clinical trial[J]. JAMA Cardiol，2023，8（4）：366-375.

KARIO K，RAKUGI H，YARIMIZU D，et al. Twenty-four-hour blood pressure-lowering efficacy of sacubitril/valsartan versus olmesartan in Japanese patients with essential hypertension based on nocturnal blood pressure dipping status：a post hoc analysis of data from a randomi-zed，double-blind multicenter study[J]. J Am Heart Assoc，2023，12（8）：e027612.

NISHIO H，ISHII A，YAMADA H，et al. Sacubitril/valsartan ameliorates renal tubulointerstitial injury through increasing renal plasma flow in a mouse model of type 2 diabetes with aldosterone excess[J]. Nephrol Dial Transplant，2023，38（11）：2517-2527.

《中国高血压防治指南》修订委员会. 中国高血压防治指南：2018年修订版[J]. 心脑血管病防治，2019，19（1）：1-44.

Revision Committee of the Chinese Guidelines for the Prevention and Treatment of Hypertension. Guidelines for prevention and treatment of hypertension in China： revised in 2018[J]. Cardio Cerebrovasc Dis Prev Treat，2019，19（1）：1-44.

上海慢性肾脏病早发现及规范化诊治与示范项目专家组，高翔，梅长林. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志，2017，37（1）：28-34.

Expert Group on Early Detection，Diagnosis and Treatment System Construction of Chronic Kidney Disease in Shanghai，GAO X，MEI C L. Guideline for screening，diag-nosis，prevention and treatment of chronic kidney disease[J]. Chin J Pract Intern Med，2017，37（1）：28-34.

ZHENG S H，ZHANG Y J，GU L，et al. Renal safety of sacubitril/valsartan：a meta-analysis of randomized controlled trials[J]. J Cardiovasc Pharmacol，2023，81（2）：93-103.

MANN D L，GIVERTZ M M，VADER J M，et al. Effect of treatment with sacubitril/valsartan in patients with advanced heart failure and reduced ejection fraction：a rando-mized clinical trial[J]. JAMA Cardiol，2022，7（1）：17-25.

CAUSLAND F R M，LEFKOWITZ M P，CLAGGETT B，et al. Angiotensin-neprilysin inhibition and renal outcomes in heart failure with preserved ejection fraction[J]. Circulation，2020，142（13）：1236-1245.

MCMURRAY J J，PACKER M，DESAI A S，et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. N Engl J Med，2014，371（11）：993-1004.

SOLOMON S D，MCMURRAY J J V，ANAND I S，et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction[J]. N Engl J Med，2019，381（17）：1609-1620.

KIM Y S，BRAR S，D’ALBO N，et al. Five years of sacubitril/valsartan：a safety analysis of randomized clinical trials and real-world pharmacovigilance[J]. Cardiovasc Drugs Ther，2022，36（5）：915-924.

LAUDER L，MAHFOUD F，AZIZI M，et al. Hypertension management in patients with cardiovascular comorbidities[J]. Eur Heart J，2023，44（23）：2066-2077.

JIA R Y，ZHANG X J，XU Y Z，et al. Effect of sacubitril/valsartan on renal function in patients with chronic kidney disease and heart failure with preserved ejection fraction：a real-world 12-week study[J]. Eur J Pharmacol，2022，928：175053.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据