Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study

• Published in: Clinical journal of the American Society of Nephrology 2018-05, Vol.13 (5), p.727-734
• Main Authors: Schroeder, Emily B, Chonchol, Michel, Shetterly, Susan M, Powers, J David, Adams, John L, Schmittdiel, Julie A, Nichols, Gregory A, O'Connor, Patrick J, Steiner, John F
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin Receptor Antagonists - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Antihypertensive Agents - adverse effects; Calcium Channel Blockers - adverse effects; Diabetes Complications - drug therapy; Drug Therapy, Combination; Female; Glomerular Filtration Rate - drug effects; Humans; Hypertension - drug therapy; Kidney - drug effects; Male; Middle Aged; Original; Proportional Hazards Models; Sodium Chloride Symporter Inhibitors - adverse effects
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.09510817

In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown. We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added -blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting. The composite significant kidney event end point was defined as the first occurrence of a ≥30% decline in eGFR to an eGFR