Satoh Michihiro, Hirose Takuo, Satoh Hironori, Nakayama Shingo, Obara Taku, Murakami Takahisa, Muroya Tomoko, Asayama Kei, Kikuya Masahiro, Mori Takefumi, Imai Yutaka, Ohkubo Takayoshi, Metoki Hirohito
Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University.
Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University.
J Hypertens. 2022 Aug 1;40(8):1564-1576. doi: 10.1097/HJH.0000000000003186. Epub 2022 Jul 5.
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.
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.
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.
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.
这项观察性回顾性队列研究使用未接受过治疗、无肾脏疾病的高血压人群的纵向真实世界健康数据，调查血管紧张素II受体阻滞剂（ARB）或二氢吡啶类钙通道阻滞剂（dCCB）单药降压治疗对肾功能的影响。
利用倾向评分匹配法，我们根据2008年至2020年的年度健康检查和理赔记录，选择了未接受治疗的高血压参与者（n = 10151）以及dCCB新使用者（n = 5078）或ARB新使用者（n = 5073）。参与者根据首次开具的药物进行分组。
平均年龄为51岁，79%为男性，平均估计肾小球滤过率（eGFR）为每1.73平方米78毫升/分钟。两个治疗组的血压均迅速下降了约10%。在1年随访时，ARB组的eGFR水平下降了近2%，而dCCB组的eGFR水平上升了不到1%。然而，在1年随访后的年度eGFR变化中，没有明显的显著差异。复合肾脏结局（新发蛋白尿或eGFR下降≥30%）的风险在ARB组中最低，这是因为其对预防蛋白尿有显著作用：与在改变降压治疗前最后一次随访结束随访时的未治疗组相比，dCCB组蛋白尿的风险比（95%置信区间）为0.91（0.78 - 1.05），ARB组为0.54（0.44 - 0.65）。
基于目前真实世界数据的研究结果，即使在基层医疗环境中，也可推荐使用ARB进行肾脏保护。同时，dCCB治疗最初会使eGFR升高，且对蛋白尿无不良影响。
