Format

Send to

Choose Destination
Clin J Am Soc Nephrol. 2018 May 7;13(5):727-734. doi: 10.2215/CJN.09510817. Epub 2018 Mar 23.

Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study.

Author information

1
Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Emily.b.schroeder@kp.org.
2
Divisions of Endocrinology, Metabolism and Diabetes and.
3
Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado.
4
Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
5
Center for Effectiveness and Safety Research, Kaiser Permanente, Pasadena, California.
6
Division of Research, Kaiser Permanente Northern California, Oakland, California.
7
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; and.
8
HealthPartners Institute and HealthPartners Center for Chronic Care Innovation, Minneapolis, Minnesota.

Abstract

BACKGROUND AND OBJECTIVES:

In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown.

DESIGN, SETTING PARTICIPANTS, & MEASUREMENTS:

We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added β-blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting. The composite significant kidney event end point was defined as the first occurrence of a ≥30% decline in eGFR to an eGFR<60 ml/min per 1.73 m2, initiation of dialysis, or kidney transplant. The composite cardiovascular event end point was defined as the first occurrence of hospitalization for acute myocardial infarction, acute coronary syndrome, stroke, or congestive heart failure; coronary artery bypass grafting; or percutaneous coronary intervention, and it was only examined in those free of cardiovascular disease at baseline.

RESULTS:

Over a maximum of 5 years, there were 4707 significant kidney events, 1498 deaths, and 818 cardiovascular events. Compared with thiazide diuretics, hazard ratios for significant kidney events for β-blockers, calcium channel blockers, and loop diuretics were 0.81 (95% confidence interval, 0.74 to 0.89), 0.67 (95% confidence interval, 0.58 to 0.78), and 1.19 (95% confidence interval, 1.00 to 1.41), respectively. Compared with thiazide diuretics, hazard ratios of mortality for β-blockers, calcium channel blockers, and loop diuretics were 1.19 (95% confidence interval, 0.97 to 1.44), 0.73 (95% confidence interval, 0.52 to 1.03), and 1.67 (95% confidence interval, 1.31 to 2.13), respectively. Compared with thiazide diuretics, hazard ratios of cardiovascular events for β-blockers, calcium channel blockers, and loop diuretics compared with thiazide diuretics were 1.65 (95% confidence interval, 1.39 to 1.96), 1.05 (95% confidence interval, 0.80 to 1.39), and 1.55 (95% confidence interval, 1.05 to 2.27), respectively.

CONCLUSIONS:

Compared with thiazide diuretics, calcium channel blockers were associated with a lower risk of significant kidney events and a similar risk of cardiovascular events.

KEYWORDS:

Acute Coronary Syndrome; Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Angiotensins; Antihypertensive Agents; Calcium Channel Blockers; Cohort Studies; Coronary Artery Bypass; Dihydropyridines; Myocardial Infarction; Peptidyl-Dipeptidase A; Percutaneous Coronary Intervention; Propensity Score; Proportional Hazards Models; Sodium Chloride Symporter Inhibitors; Sodium Potassium Chloride Symporter Inhibitors; Stroke; aldosterone; cardiovascular disease; diabetes mellitus; heart failure; hypertension; kidney disease

PMID:
29572286
PMCID:
PMC5969476
[Available on 2019-05-07]
DOI:
10.2215/CJN.09510817

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center