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

doi:10.1111/ctr.13803

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 journal › Article › peer-review

6 Scopus citations

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 language	English
Article number	e13803
Journal	Clinical Transplantation
Volume	34
Issue number	3
DOIs	https://doi.org/10.1111/ctr.13803
State	Published - Mar 1 2020

Keywords

antihypertensive medications
kidney transplant
pharmacoepidemiology
practice patterns

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10.1111/ctr.13803

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Koraishy, F. M., Yamout, H., Naik, A. S., Zhang, Z., Schnitzler, M. A., Ouseph, R., Lam, N. N., Dharnidharka, V. R., Axelrod, D., Hess, G. P., Segev, D. L., Kasiske, B. L., & Lentine, K. L. (2020). Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation. Clinical Transplantation, 34(3), Article e13803. https://doi.org/10.1111/ctr.13803

@article{804beafec2ff4a9782f8eb48cdb648a4,

title = "Impacts of center and clinical factors in antihypertensive medication use after kidney transplantation",

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.",

keywords = "antihypertensive medications, kidney transplant, pharmacoepidemiology, practice patterns",

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

note = "Publisher Copyright: {\textcopyright} 2020 John Wiley \& Sons A/S. Published by John Wiley \& Sons Ltd",

year = "2020",

month = mar,

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doi = "10.1111/ctr.13803",

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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.

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 - https://www.scopus.com/pages/publications/85080115432

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 -

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

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