Add-On Antihypertensives Compared in Patients With Diabetes on ACEIs, ARBs

Over the study period, there were 4707 significant kidney events
Over the study period, there were 4707 significant kidney events

Calcium channel blockers were associated with a reduced risk of significant renal events when used as as add-on therapy in patients with diabetes taking either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), according to a study published in the Clinical Journal of the American Society of Nephrology. 

To investigate the safety of add-on antihypertensive therapy in patients with diabetes taking ACEIs or ARBs, researchers performed an observational, multicenter study (N=21,987) to compare clinical outcomes (kidney events, cardiovascular events, death) associated with the addition of beta-blockers, dihydropyridine calcium channel blockers, loop diuretics or thiazide diuretics.

The composite significant kidney event end point was defined as the first occurrence of ≥30% decline in eGFR to an eGFR <60mL/min/1.73m2, initiation of dialysis or kidney transplant. The composite cardiovascular endpoint, only evaluated among those without cardiovascular disease at baseline, was defined as first occurrence of hospitalization for acute myocardial infarction (AMI), acute coronary syndrome, stroke or congestive heart failure (CHF); coronary artery bypass grafting; or percutaneous coronary intervention.

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A total of 4,707 significant kidney events, 818 cardiovascular events, and 1,498 deaths were identified over the 5-year period. The hazard ratios (HRs) for significant kidney events were 0.81 (95% CI: 0.74–0.89) for beta-blockers, 0.67 (95% CI: 0.58–0.78) for calcium channel blockers, and 1.19 (95% CI: 1.00–1.41) for loop diuretics, all compared with thiazide diuretics. 

The HRs for cardiovascular events compared with thiazide diuretics were 1.65 (95% CI: 1.39–1.96) for beta-blockers, 1.05 (95% CI: 0.80–1.39) for calcium channel blockers, and 1.55 (95% CI: 1.05–2.27) for loop diuretics. Moreover, the HRs for mortality compared with thiazide diuretics were 1.19 (95% CI: 0.97–1.44) for beta-blockers, 0.73 (95% CI: 0.52–1.03) for calcium channel blockers, and 1.67 (95% CI: 1.31–2.13) for loop diuretics. 

Based on their findings, the authors concluded that in patients with diabetes on angiotensin-aldosterone system blockers, "compared with thiazide diuretics, calcium channel blockers were associated with a lower risk of significant kidney events and a similar risk of cardiovascular events."

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