Abstract: SA-PO536
Association of Antihypertensive Medications with Cardiovascular (CV) Outcomes in Patients with CKD
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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