ARBs protect kidney function in hypertensive patients

A recent study using real-world data has found that antihypertensive therapy with angiotensin II receptor blockers (ARBs) can be initiated for kidney protection even in a primary care setting.

On the other hand, treatment with dihydropyridine calcium channel blockers (dCCBs) initially elevates estimated glomerular filtration rate (eGFR) with no adverse effects on proteinuria.

In this observational retrospective cohort study, a group of researchers used propensity score matching to select 10,151 untreated hypertensive individuals (mean age 51 years, 79 percent men, mean eGFR 78 ml/min per 1.73 m²), as well as 5,078 dCCB and 5,073 ARB new users based on annual health check-ups and claims between 2008 and 2020. They divided participants according to the first prescribed drug.

Blood pressure decreased fast by about 10 percent in both treatment groups. At 1 year, eGFR levels decreased by nearly 2 percent in the ARB group but increased by <1 percent in the dCCB group. However, no significant between-group difference was noted in the annual eGFR change after 1 year.

Notably, the ARB group had the lowest risk for composite kidney outcome (ie, new-onset proteinuria or eGFR decline ≥30 percent) due to their robust effect on preventing proteinuria (dCCB group: hazard ratio [HR], 0.91, 95 percent confidence interval [CI], 0.78‒1.05; ARB group: HR, 0.54, 95 percent CI, 0.44‒0.65), relative to that for the untreated group after ending follow-up at the last visit before changing antihypertensive treatment.