Using 4 or More BP-Lowering Drugs Causes Detrimental Renal Events

The use of 4 or more antihypertensive drug classes is associated with detrimental renal events, according to an analysis of the Systolic Blood Pressure Intervention Trial (SPRINT).

Findings were presented at the American Society of Nephrology’s Kidney Week 2017, which is taking place from October 31 to November 5, 2017, in New Orleans, Louisiana.
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The results of SPRINT indicated that a higher number of drugs was needed to achieve target systolic blood pressure levels in the intensive arm. Although intensive treatment was associated with lower rates of cardiovascular events, it was found to increase the incidence of adverse events.

For their analysis, the researchers assessed 8449 participants in SPRINT. Latent Class Mixed Modeling and the number of drug classes prescribed at baseline and at 1, 2, 3, 6, 9, and 12 months were used to determine distinct trajectory groups in the standard and intensive arms.

The association between drug class trajectories and renal adverse events was investigated using Cox-PH models. Findings were adjusted for age, sex, SBP (area under the curve [AUC] 0-12 months), prevalent cardiovascular disease, prevalent CKD, and the number of drug classes at baseline.

Patients with an SBP of less than 125 who were taking 2.5 drugs were used as a reference category. According to the Cox-PH model, those with an SBP of 125 who were taking 4 drug classes had an increased risk for a 30% reduction in estimated glomerular filtration rate (eGFR), whereas those with an SBP of 133 who were taking 1.5 drugs had a lower risk of a 30% reduction in eGFR but a trend toward a higher risk for acute kidney injury.

“Within the intensive arm of the SPRINT, treatment with [4 or more] antihypertensive drug classes was associated with adverse renal events, independent of BP achieved in the first year,” the researchers concluded.

—Christina Vogt

Reference:

Dasgupta I, Mccallum L, Jardine AG, Padmanabhan S. The use of four or more drugs for intensive control of blood pressure is associated with detrimental renal effects in the SPRINT. Paper presented at: American Society of Nephrology Kidney Week 2017; October 31-November 5, 2017; New Orleans, LA. https://www.asn-online.org/education/kidneyweek/2017/program-abstract.aspx?controlId=2788777.