Sacubitril/Valsartan Treats Patients With Essential Hypertension and Type 2 Diabetic Nephropathy

A Prospective, Randomized, Controlled, Multicenter Study of Sacubitril/Valsartan in the Treatment of Patients With Mild to Moderate Essential Hypertension and Type 2 Diabetic Nephropathy: The Hyper-Save Study

This study aims to compare the efficacy and safety of Sacubitril/Valsartan versus Valsartan in patients with essential hypertension and type 2 diabetic nephropathy over a 12-week treatment period, including two treatment groups, with a total of 297 eligible subjects randomly assigned in a 2:1 ratio to either the experimental group or the control group.Subjects will participate in the study through two phases: the screening period and the follow-up period.The primary outcome measure is the change in systolic blood pressure from baseline after 12 weeks of treatment.

Inclusion Criteria:

• Age 18 years or older, no gender restriction;
• Diagnosed with mild to moderate primary hypertension (140 ≤ SBP < 180 mmHg and/or 90 ≤ DBP < 110 mmHg), including newly diagnosed or inadequately treated patients (those who have not followed previous medical advice and have uncontrolled blood pressure according to the investigator);
• Diagnosed with type 2 diabetes (according to Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)), and meeting the following conditions: a) Continuously on ≥ 1 glucose control medication regimens (which may include long-acting insulin) for at least 12 weeks before screening, with a stable treatment regimen (i.e., the same medication and dosage) for at least 28 days before screening, and maintaining this regimen during the study. At the investigator's discretion, the dose of supplemental short-acting insulin can be adjusted as needed to achieve adequate glucose control; b) HbA1c level ≤ 10.5% and fasting (≥ 8 hours) plasma glucose level ≤ 13.3 mmol/L (if fasting glucose > 13.3 mmol/L, the investigator may repeat the test to determine eligibility);
• Urine albumin/creatinine ratio (UACR) ≥ 30 mg/g in two measurements taken on separate days or eGFR < 60 mL/min/1.73 m²;
• Non-pregnant or fertile patients (male or female) using reliable contraception;
• Female patients with potential for pregnancy must have a negative pregnancy test at screening;
• Subjects must voluntarily agree to comply strictly with the study protocol requirements and sign a written informed consent form.

Exclusion Criteria:

• Presence of severe hypertension, malignant hypertension, hypertensive emergencies, or hypertensive crises;
• History or evidence of secondary hypertension within 12 months before screening, including but not limited to any of the following: renovascular hypertension, renal parenchymal hypertension, unilateral or bilateral renal artery stenosis, coarctation of the aorta, primary aldosteronism, Cushing's disease, pheochromocytoma, polycystic kidney disease, and drug-induced hypertension;
• History of angioedema (drug-related or other causes) within 12 months before screening;
• Presence of diabetic ketoacidosis;
• History or evidence of secondary diabetes within 12 months before screening, including but not limited to any of the following: endocrine disorders causing carbohydrate metabolism disorders, pancreatogenic diabetes, hepatogenic diabetes, nephrogenic diabetes, etc.;
• History of malignancy in any organ system (excluding localized basal cell carcinoma of the skin);
• History of acute stroke, lacunar infarction, or dementia within 6 months before screening;
• History of coronary artery bypass graft surgery or any percutaneous coronary intervention (PCI) within 6 months before screening;
• Previously diagnosed or currently diagnosed heart failure (NYHA Class III-IV) or clinically significant valvular heart disease;
• History or current diagnosis of cardiac abnormalities: (1) second or third-degree atrioventricular block without a pacemaker; (2) clinically significant arrhythmias, including atrial fibrillation with a ventricular rate ≥ 120 bpm; (3) family history of long QT syndrome or torsades de pointes ventricular tachycardia;
• Chronic kidney disease stage 4 or higher (eGFR < 30 mL/min/1.73 m²), receiving renal dialysis, or history of kidney transplantation;
• Significant abnormalities in laboratory tests, such as potassium levels > 5.5 mmol/L or < 3.5 mmol/L, sodium levels < 130 mmol/L, liver function (ALT, AST) results > 3 times the upper limit of normal;
• History of allergy to antihypertensive drugs such as ARBs, Angiotensin-Converting Enzyme (ACE) inhibitors, or renin inhibitors;
• Clear history of intolerance to drugs similar to the study medication (e.g., ACE inhibitors, ARBs);
• Use of traditional Chinese or Western medicines that could affect the study's efficacy during the study period (see appendix for list);
• Any surgery or medical condition that significantly alters the absorption, distribution, metabolism, or excretion of any medication, including but not limited to the following: clinically significant gastrointestinal surgery within 12 months before the screening (e.g., gastrectomy, gastrointestinal anastomosis, bowel resection, gastric bypass, gastroenterostomy, or gastric banding), current active inflammatory bowel disease or history of active inflammatory bowel disease;
• Pregnant or breastfeeding women, or patients of childbearing potential unwilling or unable to use effective contraception during the study period;
• Participation in another clinical study using any investigational drug or observational study within 30 days before screening;
• Other conditions that, in the investigator's judgment, may affect the conduct of the clinical study or the determination of study results.