Abstract: FR-PO754
Dihydropyridine Calcium Channel Blockers and Incident Albuminuria
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Blum, Matthew F., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Surapaneni, Aditya L., New York University Grossman School of Medicine, New York, New York, United States
- Chang, Alex R., Geisinger Health, Danville, Pennsylvania, United States
- Inker, Lesley Ann, Tufts Medical Center, Boston, Massachusetts, United States
- Shin, Jung-Im, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
Background
Dihydropyridine calcium channel blockers (DHP-CCB) are first-line blood pressure agents that promote systemic vasodilation. In the kidney, they disproportionality vasodilate the afferent arteriole relative to the efferent arteriole, which poses a risk of glomerular hypertension and consequent albuminuria. For this reason, the amlodipine arm was halted early in the African American Study of Kidney Disease and Hypertension. However, DHP-CCBs remain commonly used, and few real-world studies have examined the development albuminuria with DHP-CCB use. Therefore, we sought to measure the association of DHP-CCBs with incident albuminuria compared to beta blockers, an active comparator not known to affect albuminuria.
Methods
We included 61,380 patients without known albuminuria who initiated either a DHP-CCB or beta blocker in a cohort from the Geisinger Health System from 2004-2019. We performed 1:1 propensity matching on age, sex, race, systolic and diastolic blood pressure, eGFR, smoking, body mass index, heart failure, diabetes, stroke, and coronary heart disease. We estimated risk of incident albuminuria (albumin to creatinine ratio [ACR] > 300 mg/g, protein to creatinine ratio converted to ACR, or urinalysis with > 2+ protein) using Cox proportional hazards regression.
Results
After matching, there were 28,716 patients (14,358 per group). Mean age was 60.5 years, mean systolic blood pressure was 142 mmHg, mean eGFR was 84 ml/min/1.73 m2, and 1.8% had heart failure. 2244 (7.8%) patients developed albuminuria over an average 4.8 years of follow up. DHP-CCB initiation was associated with a significantly higher risk of albuminuria compared to beta blocker initiation (hazard ratio 1.37 [95% confidence interval, 1.26-1.50]; Figure).
Conclusion
Compared to beta blockers, DHP-CCB use was associated with increased risk of incident albuminuria in a community cohort.
Cumulative incidence of albuminuria in DHP-CCB vs beta blocker use
Funding
- Other NIH Support