Key result
Antihypertensive regimens including beta-blockers and diuretics are linked to better BP control in CKD.
Why the study?
Do specific antihypertensive regimens improve blood pressure control in ambulatory patients with chronic kidney disease and hypertension?
Observational (n=5,658)
Do specific antihypertensive regimens improve blood pressure control in ambulatory patients with chronic kidney disease and hypertension?
In ambulatory CKD patients, regimens including a beta-blocker plus diuretic or ACEI/ARB plus beta-blocker plus diuretic are associated with better BP control, though one-third of patients are not prescribed guideline-recommended ACEI/ARB therapy.
May support regimen optimization in CKD hypertension; leaves open whether associations reflect causation or confounding.
We used electronic health records (EHRs) data from 5658 ambulatory chronic kidney disease (CKD) patients with hypertension and prescribed antihypertensive therapy to examine antihypertensive drug prescribing patterns, blood pressure (BP) control, and risk factors for resistant hypertension (RHTN) in a real-world setting. Two-thirds of CKD patients and three-fourths of those with proteinuria were prescribed guideline-recommended renoprotective agents including an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB); however, one-third were not prescribed an ACEI or ARB. CKD patients, particularly those with stages 1-2 CKD, who were prescribed regimens including beta-blocker (BB) + diuretic or ACEI/ARB + BB + diuretic were more likely to have controlled BP (<140/90 mm Hg) compared to those prescribed other combinations. Risk factors for RHTN included African American race and major comorbidities. Clinicians may use these findings to tailor antihypertensive therapy to the needs of each patient, including providing CKD stage-specific treatment, and better identify CKD patients at risk of RHTN.
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Magvanjav et al. (2018) conducted an observational in Chronic kidney disease with hypertension (n=5,658). Antihypertensive therapy regimens (BB + diuretic or ACEI/ARB + BB + diuretic) vs. Other antihypertensive combinations was evaluated on Blood pressure control (<140/90 mm Hg) and risk factors for resistant hypertension. Guideline-recommended ACEI or ARB therapy was prescribed to two-thirds of CKD patients, while regimens including beta-blockers and diuretics were associated with better blood pressure control.
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