Abstract: TH-PO1027
Patient- and Provider-Related Factors Associated with Changes in Antihypertensive Treatment in CKD
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Costes-Albrespic, Margaux, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Liabeuf, Sophie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
- Laville, Solene M., Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
- Fouque, Denis, Cardiovasculaire Metabolisme Diabetologie et Nutrition, Pierre Benite, France
- Laville, Maurice, Cardiovasculaire Metabolisme Diabetologie et Nutrition, Pierre Benite, Auvergne-Rhône-Alpes , France
- Frimat, Luc, Centre Hospitalier Regional Universitaire de Nancy, Nancy, Grand Est, France
- Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Lambert, Oriane, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
- Massy, Ziad, Hopital Ambroise-Pare, Boulogne-Billancourt, Île-de-France, France
- Sautenet, Bénédicte, Centre Hospitalier Regional Universitaire de Tours, Tours, Centre-Val de Loire, France
- Alencar de Pinho, Natalia, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
Background
Despite the existence of effective antihypertensive drugs, blood pressure (BP) remains off-target in a large number of CKD patients. We aimed to assess patient- and provider-related factors associated with changes in antihypertensive drug prescription in CKD.
Methods
We included 2,755 patients with CKD stages 3–4 and hypertension, under nephrology care, from the French CKD-REIN cohort study. We collected all drug prescriptions over 5 years and classified antihypertensive drugs in 14 mutually exclusive classes. We estimated cause-specific hazard ratios (HR) of add-on and withdrawal of antihypertensive drugs associated with patient- and provider-related factors by using hierarchical shared-frailty models, and accounting for clustering at the nephrologist level.
Results
At baseline, 81% of the patients (median age, 69; 66% men; mean eGFR 33 mL/min/1.73 m2) had BP ≥ 130/80 mmHg. Over a median 5-year follow-up (IQR 4.6-5.2), the rates of any antihypertensive drug class change, add-on, withdrawal, and switch were 50, 23, 25, and 4 per 100 person-years, respectively. In multivariable models, drug add-on hazard was higher for older patients (HR, 1.11; 95% confidence interval [CI], 1.04-1.18), for those with higher BMI (HR, 1.04 95% CI, 1.01-1.07), and poor medication adherence (HR, 1.39; 95% CI, 1.10-1.68). Drug withdrawal hazard was higher for patients with cardiovascular history (HR, 1.19 95% CI, 1.04-1.35), and those with shorter formal education (HR, 1.23; 95% CI, 1.02-1.45 for 9-11 years versus ≥12). The higher the number of nephrologist visits, the higher the add-on and withdrawal hazards (HR for ≥4 versus none, 1.50; 95% CI 1.14-1.86 and 1.57; 1.24-1.90, respectively). Associations with withdrawals and add-ons of antihypertensive drug prescriptions and the number of other physicians’ visits differed according to their specialty.
Conclusion
Our findings highlight the dynamics of antihypertensive drug prescriptions in the search for BP control, with heterogeneity in practices among the multiple physicians involved in the care of CKD patients.
Funding
- Commercial Support – Fresenius Medical Care; GlaxoSmithKline; Vifor France; Sanofi-Genzyme; Baxter and Merck Sharp & Dohme-Chibret; Amgen; Lilly France; Otsuka Pharmaceutical; AstraZeneca; and Boehringer Ingelheim France