Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA.
Division of Nephrology, Department of Medicine, Saint Louis University, St. Louis, MO, USA.
Clin Transplant. 2020 Mar;34(3):e13803. doi: 10.1111/ctr.13803. Epub 2020 Feb 29.
Hypertension guidelines recommend calcium channel blockers (CCBs), thiazide diuretics, and angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) as first-line agents to treat hypertension. Hypertension is common among kidney transplant (KTx) recipients, but data are limited regarding patterns of antihypertensive medication (AHM) use in this population. We examined a novel database that links national registry data for adult KTx recipients (age > 18 years) with AHM fill records from a pharmaceutical claims warehouse (2007-2016) to describe use and correlates of AHM use during months 7-12 post-transplant. For patients filling AHMs, individual agents used included: dihydropyridine (DHP) CCBs, 55.6%; beta-blockers (BBs), 52.8%; diuretics, 30.0%; ACEi/ARBs, 21.1%; non-DHP CCBs, 3.0%; and others, 20.1%. Both BB and ACEi/ARB use were significantly lower in the time period following the 2014 Eighth Joint National Committee (JNC-8) guidelines (2014-2016), compared with an earlier period (2007-2013). The median odds ratios generated from case-factor adjusted models supported variation in use of ACEi/ARBs (1.51) and BBs (1.55) across transplant centers. Contrary to hypertension guidelines for the general population, KTx recipients are prescribed relatively more BBs and fewer ACEi/ARBs. The clinical impact of this AHM prescribing pattern warrants further study.
高血压指南推荐钙通道阻滞剂（CCB）、噻嗪类利尿剂和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARB）作为治疗高血压的一线药物。高血压在肾移植（KTx）受者中很常见，但关于该人群中抗高血压药物（AHM）使用模式的数据有限。我们检查了一个新的数据库，该数据库将成年 KTx 受者（年龄>18 岁）的国家登记数据与来自药品索赔仓库的 AHM 填充记录（2007-2016 年）相关联，以描述移植后 7-12 个月期间 AHM 的使用情况及其相关性。对于使用 AHM 的患者，使用的个体药物包括：二氢吡啶（DHP）CCB，55.6%；β受体阻滞剂（BB），52.8%；利尿剂，30.0%；ACEi/ARB，21.1%；非 DHP CCB，3.0%；以及其他，20.1%。与较早时期（2007-2013 年）相比，在 2014 年第八届联合国家委员会（JNC-8）指南（2014-2016 年）之后的时间段内，BB 和 ACEi/ARB 的使用明显较低。来自病例因素调整模型的中位数优势比支持 ACEi/ARB（1.51）和 BB（1.55）在移植中心之间的使用变化。与一般人群的高血压指南相反，KTx 受者开处方的 BB 相对较多，而 ACEi/ARB 较少。这种 AHM 处方模式的临床影响值得进一步研究。
