Use of Antihypertensive Agents and Association With Risk of Adverse Outcomes in Chronic Kidney Disease: Focus on Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers.
Use of Antihypertensive Agents and Association With Risk of Adverse Outcomes in Chronic Kidney Disease: Focus on Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers.
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DOI：
10.1161/jaha.118.009992
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发表时间：
2018-10-02
影响因子：
5.4
通讯作者：
Johansen KL
中科院分区：
文献类型：
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作者：
Ku E;McCulloch CE;Vittinghoff E;Lin F;Johansen KL
我们的目的是根据慢性肾脏病(CKD)的分期确定抗高血压药的使用模式，并评估不同类别的抗高血压药与非肾脏结局的相关性，特别是在晚期CKD中。我们研究了CRIC(慢性肾功能不全队列)研究的3939名参与者。预测因素是时间依赖的血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β阻滞剂和钙通道阻滞剂的使用(与未使用每类药物相比)。结果是判断心力衰竭事件或死亡。调整后的COX模型被用来确定预测因素和结果之间的关联。我们还检查了CKD的严重程度(早期[2-3期CKD]与晚期[4-5期CKD])的相关性是否存在差异。在7.5年的中位随访期中，肾素-血管紧张素-醛固酮系统抑制剂的使用在慢性肾脏病第3期(75%)保持平稳，到第5期下降到37%，而β受体阻滞剂、钙通道阻滞剂和利尿剂的使用量随着慢性肾脏病的进展而稳步增加。肾素-血管紧张素-醛固酮系统抑制剂的使用与较低的心力衰竭风险(风险比，0.79；95%可信区间，0.67-0.97)和死亡(风险比，0.78；95%可信区间，0.67-0.90)相关，与CKD的严重程度无关。无论CKD的严重程度如何，钙通道阻滞剂的使用与心力衰竭或死亡的风险无关。β阻滞剂的使用与心力衰竭的风险(风险比1.62；95%可信区间1.29-2.04)和死亡(风险比1.22；95%可信区间1.03-1.43)相关，尤其是在慢性肾脏病早期(P<；0.05交互作用)。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂的使用减少，而其他药物的使用随着CKD的进展而增加。使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂以外的药物可能与慢性肾脏病患者预后不佳有关。
Our objective was to determine patterns of antihypertensive agent use by stage of chronic kidney disease (CKD) and to evaluate the association between different classes of antihypertensive agents with nonrenal outcomes, especially in advanced CKD. We studied 3939 participants of the CRIC (Chronic Renal Insufficiency Cohort) study. Predictors were time‐dependent angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker , β‐blocker, and calcium channel blocker use (versus nonuse of agents in each class). Outcomes were adjudicated heart failure events or death. Adjusted Cox models were used to determine the association between predictors and outcomes. We also examined whether the associations differed based on the severity of CKD (early [stage 2–3 CKD] versus advanced disease [stage 4–5 CKD]). During median follow‐up of 7.5 years, renin‐angiotensin‐aldosterone system inhibitor use plateaued during CKD stage 3 (75%) and declined to 37% by stage 5, while β‐blocker, calcium channel blocker, and diuretic use increased steadily with advancing CKD. Renin‐angiotensin‐aldosterone system inhibitor use was associated with lower risk of heart failure (hazard ratio, 0.79; 95% confidence interval, 0.67–0.97) and death (hazard ratio, 0.78; 95% confidence interval, 0.67–0.90), regardless of severity of CKD. Calcium channel blocker use was not associated with risk of heart failure or death, regardless of the severity of CKD. β‐Blocker use was associated with higher risk of heart failure (hazard ratio, 1.62; 95% confidence interval, 1.29–2.04) and death (hazard ratio, 1.22; 95% confidence interval, 1.03–1.43), especially during early CKD (P<0.05 for interaction). Angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker use decreased, while use of other agents increased with advancing CKD. Use of agents besides angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers may be associated with suboptimal outcomes in patients with CKD.