ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: SA-PO536

Association of Antihypertensive Medications with Cardiovascular (CV) Outcomes in Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
  • Perkins, Aaron Rode, Texas Tech University Health Sciences Center School of Pharmacy - Dallas, Dallas, Texas, United States
  • Yang, Hui, Texas Tech University Health Sciences Center School of Pharmacy - Dallas, Dallas, Texas, United States
  • Nambi, Vijay, Baylor College of Medicine, Houston, Texas, United States
  • Hedayati, Susan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Alvarez, Carlos A., Texas Tech University Health Sciences Center School of Pharmacy - Dallas, Dallas, Texas, United States
Background

Angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) are first line for hypertension in patients with CKD. Whether the second agent prescribed is associated with CV events is less clearly established.

Methods

Using the Veterans Affairs Corporate Data Warehouse, we identified veterans with CKD stages 1-5 based on estimated glomerular filtration rate and albuminuria from 1/1/2010 to 12/31/2016. We selected individuals prescribed an ACEi/ARB as monotherapy for hypertension at or prior to the time of prescription of a second antihypertensive agent (index date), grouped by thiazide diuretics (TD), loop diuretics (LD), calcium channel blockers (CCB), and beta blockers (BB). The primary outcome was the composite of hospitalization for heart failure or fatal or non-fatal myocardial infarction or stroke, or revascularization. Inverse probability of treatment weights (IPTW) were generated using generalized boosted methods, and Cox proportional hazards regression assessed associations between medications and CV events.

Results

Of the 328,399 participants, 98,222 (30%) were prescribed TD, 39,202 (12%) LD, 71,091 (22%) CCB, and 119,884 (36%) BB. The mean age was 71 years, 97% were men, 72% were White, and 18% were Black. Compared to the other groups, TD users were younger, more likely to be female, and less likely to have CKD stages 4 or 5. Heart failure was more common among users of LD (36%) and BB (18%) compared to TD (3%). Weighted standardized differences demonstrated that characteristics were balanced between groups after IPTW. There were 111,124 composite CV events. Compared to TD, increased hazard of CV events was seen for LD, CCB, and BB users (Figure).

Conclusion

Although residual indication bias cannot be excluded, these data suggest that there may be an increased risk of CV events with LD, CCB, and BB compared to TD in those with CKD. Examination of the reasons to initiate these agents is warranted.

Funding

  • Veterans Affairs Support