Antihypertensive Medications and Change in Stages of Chronic Kidney Disease.

Objectives: The goal of this study is to estimate the change in the relationships between use of five classes of antihypertensive medications and stages of Chronic Kidney Disease (CKD) in American adults treated for hypertension.

Methods: The US National Health and Nutrition Examination Survey (NHANES) data sets 1999-2012 were used with the final analytical sample of 3,045 participants. Population prevalence estimates were calculated using the NHANES survey design weights. Inferential analyses were done with binomial logistic regression models.

Results: The odds of advanced (3, 4, and 5 combined) versus early CKD stages (1 and 2 combined) were significantly higher among patients treated with Angiotensin Receptor Blockers (ARB) versus those not treated with ARB in 2009-2012 (adjusted odds ratio (95% confidence interval) = 2.52 (1.32-4.80)). From 1999 to 2012, the increase in this relationship was significant (p = 0.0023) for users of ARB polytherapy and in users of ARB in patients with albuminuria (p = 0.0031).

Conclusion: Aggressive pharmacological management of hypertension with ARB as add-on therapy may have accelerated kidney damage in American adults. However, prospective longitudinal studies are needed to establish proper temporal sequence in this relationship.