TY - JOUR
T1 - Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation
AU - Koraishy, Farrukh M.
AU - Yamout, Hala
AU - Naik, Abhijit S.
AU - Zhang, Zidong
AU - Schnitzler, Mark A.
AU - Ouseph, Rosemary
AU - Lam, Ngan N.
AU - Dharnidharka, Vikas R.
AU - Axelrod, David
AU - Hess, Gregory P.
AU - Segev, Dorry L.
AU - Kasiske, Bertram L.
AU - Lentine, Krista L.
N1 - Funding Information:
This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. Supported in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), R01DK102981. KLL receives support from the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing portions of this work was presented at the American Transplant Congress 2018, Seattle, WA.
Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - antihypertensive medications
KW - kidney transplant
KW - pharmacoepidemiology
KW - practice patterns
UR - http://www.scopus.com/inward/record.url?scp=85080115432&partnerID=8YFLogxK
U2 - 10.1111/ctr.13803
DO - 10.1111/ctr.13803
M3 - Article
C2 - 31997429
AN - SCOPUS:85080115432
SN - 0902-0063
VL - 34
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 3
M1 - e13803
ER -