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.
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.
Authors: Robert W Schrier; Kaleab Z Abebe; Ronald D Perrone; Vicente E Torres; William E Braun; Theodore I Steinman; Franz T Winklhofer; Godela Brosnahan; Peter G Czarnecki; Marie C Hogan; Dana C Miskulin; Frederic F Rahbari-Oskoui; Jared J Grantham; Peter C Harris; Michael F Flessner; Kyongtae T Bae; Charity G Moore; Arlene B Chapman Journal: N Engl J Med Date: 2014-11-15 Impact factor: 91.245
Authors: Marie C Hogan; Kaleab Abebe; Vicente E Torres; Arlene B Chapman; Kyongtae T Bae; Cheng Tao; Hongliang Sun; Ronald D Perrone; Theodore I Steinman; William Braun; Franz T Winklhofer; Dana C Miskulin; Frederic Rahbari-Oskoui; Godela Brosnahan; Amirali Masoumi; Irina O Karpov; Susan Spillane; Michael Flessner; Charity G Moore; Robert W Schrier Journal: Clin Gastroenterol Hepatol Date: 2014-08-09 Impact factor: 11.382
Authors: Robert W Schrier; Godela Brosnahan; Melissa A Cadnapaphornchai; Michel Chonchol; Keith Friend; Berenice Gitomer; Sandro Rossetti Journal: J Am Soc Nephrol Date: 2014-06-12 Impact factor: 10.121
Authors: Melissa Millar; Youssef S Tanagho; Mohammed Haseebuddin; Ralph V Clayman; Sam B Bhayani; R Sherburne Figenshau Journal: J Endourol Date: 2013-02-05 Impact factor: 2.942