Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation

Farrukh M. Koraishy, Hala Yamout, Abhijit S. Naik, Zidong Zhang, Mark A. Schnitzler, Rosemary Ouseph, Ngan N. Lam, Vikas R. Dharnidharka, David Axelrod, Gregory P. Hess, Dorry L. Segev, Bertram L. Kasiske, Krista L. Lentine

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article numbere13803
JournalClinical Transplantation
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2020

Keywords

  • antihypertensive medications
  • kidney transplant
  • pharmacoepidemiology
  • practice patterns

ASJC Scopus subject areas

  • Transplantation

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