Use of antihypertensive medications and mortality of patients with autosomal dominant polycystic kidney disease: a population-based study

Abstract

Background: This study aimed to estimate the association between antihypertensive therapy and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD).

Study design: Cohort study.

Setting & participants: Participants with ADPKD from the UK General Practice Research Database older than 15 years between 1991 and 2008.

Predictors: Use of 5 major classes of antihypertensive drug.

Outcomes: Deaths, new renal replacement therapy events.

Measurements: Random-effects Poisson models were adjusted for age, sex, year of entry into the cohort, calendar year, prevalent coronary heart disease, stroke, diabetes, hyperlipidemia, and lipid-lowering therapy.

Results: From 1991-2008, there were 2,085 cases of ADPKD, with 1,877 contributing person-time for ages older than 15 years. In 1991, antihypertensive drugs were not prescribed for 68% of participants, which decreased to 38% by 2008. The proportion for which 1 class of antihypertensive drug was prescribed increased from 19% in 1991 to 24% in 2008; 2 classes, from 11% to 22%; 3 classes, from 2% to 11%; and 4 or 5 classes, from 1% to 5%. In 1991, drugs acting on the renin-angiotensin system were prescribed for only 7% of participants; by 2008, this had increased to 46%. There was evidence of a trend toward decreasing mortality as the number of antihypertensive drug classes prescribed in a year increased. For participants with 3 classes of drugs prescribed, the incident rate ratio was 0.11 (95% CI, 0.05-0.21; P < 0.001). Each annual increment in year of entry into the cohort was associated with a 6% (95% CI, 2%-10%; P = 0.008) decrease in mortality.

Limitations: Reported associations might be accounted for by unmeasured or incompletely measured confounders. These might include changes in other aspects of medical care for patients with ADPKD.

Conclusion: Increasing coverage and intensity of antihypertensive therapy is associated with decreasing mortality in people with ADPKD.