Angiotensin receptor–neprilysin inhibitors (ARNIs) have been approved as antihypertensive agents in Japan, and thiazide diuretics (TZDs) are widely used concomitantly with renin–angiotensin system inhibitors (RASIs) for hypertension. This retrospective study included patients with hypertension who switched from RASI to ARNI therapy (ARNI group) and those who were prescribed TZDs with RASIs (TZD/RASI group). Drug-related changes in the estimated glomerular filtration rate (eGFR), blood pressure (BP), body weight (BW), serum electrolytes, uric acid (UA), and triglyceride levels were compared between the two groups. Overall, 70 participants (31 and 39 in the ARNI and TZD/RASI groups, respectively) were enrolled and observed for a median of 2 months. According to linear mixed models, compared with the TZD/RASI group, the ARNI group exhibited a significant change in mean eGFR of 3.71 mL/min/1.73 m² [95% confidence interval (CI), 0.57–6.84; P = 0.02] from the time of switching drug to the next outpatient visit. Further, compared with the TZD/RASI group, the ARNI group exhibited significant changes in mean serum UA (−1.27; 95% CI, −1.66 to −0.88), sodium (1.22; 95% CI, 0.12 to −2.32), chloride (2.14; 95% CI, 0.75–3.52), and triglyceride (−52.1; 95% CI, −100.9 to −3.29) levels. Conversely, serum potassium levels, BW, and systolic and diastolic BP did not differ significantly between the two groups (P = 0.69, 0.44, 0.49, and 0.66, respectively). Compared with the combination therapy of TZD and RASI, ARNI therapy causes less renal dysfunction, hyperuricemia, and hypertriglyceridemia with fewer electrolyte abnormalities and no significant difference in antihypertensive effects.

血管紧张素受体-脑啡肽酶抑制剂（ARNI）已在日本被批准作为抗高血压药物，噻嗪类利尿剂（TZD）与肾素-血管紧张素系统抑制剂（RASIs）广泛联合用于治疗高血压。这项回顾性研究包括从 RASI 转为 ARNI 治疗的高血压患者（ARNI 组）和同时服用 RASI 的 TZD 患者（TZD/RASI 组）。比较两组之间估计肾小球滤过率（eGFR）、血压（BP）、体重（BW）、血清电解质、尿酸（UA）和甘油三酯水平的药物相关变化。总体而言，共有 70 名参与者（ARNI 组和 TZD/RASI 组分别为 31 名和 39 名）入组并观察中位时间为 2 个月。根据线性混合模型，与TZD/RASI组相比，ARNI组的平均eGFR出现显着变化，为3.71 mL/min/1.73 m 2 [95 ^%置信区间(CI)，0.57–6.84；P  = 0.02]从换药时到下次门诊就诊时。此外，与TZD/RASI组相比，ARNI组的平均血清UA（-1.27；95% CI，-1.66至-0.88）、钠（1.22；95% CI，0.12至-2.32）、氯有显着变化。 （2.14；95% CI，0.75-3.52）和甘油三酯（-52.1；95% CI，-100.9 至 -3.29）水平。相反，两组之间的血清钾水平、体重以及收缩压和舒张压没有显着差异（P 分别为0.69、0.44、0.49和0.66）。与TZD和RASI联合治疗相比，ARNI治疗引起的肾功能障碍、高尿酸血症和高甘油三酯血症较少，电解质异常较少，降压效果无显着差异。