Author:

Keywords:

ALBUMINURIA, angiotensin receptor antagonists, blood pressure, BLOOD-PRESSURE, calcium channel blockers, CARDIOVASCULAR OUTCOMES, Cardiovascular System & Cardiology, CHRONIC KIDNEY-DISEASE, DIABETIC-NEPHROPATHY, epidemiology and outcomes, GENERAL-POPULATION, HYPERTENSIVE PATIENTS, kidney, Life Sciences & Biomedicine, Peripheral Vascular Disease, proteinuria, RAMIPRIL, RISK, Science & Technology, TELMISARTAN, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Calcium Channel Blockers, Female, Humans, Hypertension, Kidney, Male, Middle Aged, Proteinuria, Retrospective Studies, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, 1116 Medical Physiology, Cardiovascular System & Hematology, 3201 Cardiovascular medicine and haematology, 3202 Clinical sciences

Abstract:

OBJECTIVE: This observational retrospective cohort study investigates the effect of antihypertensive therapy with angiotensin II receptor blockers (ARBs) or dihydropyridine calcium channel blockers (dCCBs) monotherapy on renal function using longitudinal real-world health data of a drug-naive, hypertensive population without kidney disease. METHODS: Using propensity score matching, we selected untreated hypertensive participants ( n  = 10 151) and dCCB ( n  = 5078) or ARB ( n  = 5073) new-users based on annual health check-ups and claims between 2008 and 2020. Participants were divided by the first prescribed drug. RESULTS: The mean age was 51 years, 79% were men and the mean estimated glomerular filtration rate (eGFR) was 78 ml/min per 1.73 m 2 . Blood pressure rapidly decreased by approximately 10% in both treatment groups. At the 1-year visit, eGFR levels decreased in the ARB group by nearly 2% but increased in the dCCB group by less than 1%. However, no significant difference was apparent in the annual eGFR change after the 1-year visit. The risk for composite kidney outcome (new-onset proteinuria or eGFR decline ≥30%) was lowest in the ARB group owing to their robust effect on preventing proteinuria: hazard ratio (95% confidence interval) for proteinuria was 0.91 (0.78-1.05) for the dCCB group and 0.54 (0.44-0.65) for the ARB group, compared with that for the untreated group after ending follow-up at the last visit before changing antihypertensive treatment. CONCLUSION: From the present findings based on the real-world data, ARBs can be recommended for kidney protection even in a primary care setting. Meanwhile, dCCB treatment initially increases eGFR with no adverse effects on proteinuria.