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.

Sociodemographic disparities in sodium‐glucose cotransporter‐2 inhibitor use among US kidney transplant recipients: An observational study of real‐world pharmacy records

“…Pharmacy fill data inherently lack information on medication indication, but have been extensively used for pharmacoepidemiology studies in the KTx and living donor populations. [28][29][30][31][32] Patterns were robust in sensitivity analysis of patients with pretransplant diabetes.…”

“…First, because our analyses were limited to claims data, we could not assess other medical information such as glycemic control, history of urinary tract infection, and functional status, which might affect the decision‐making and treatment goals. Pharmacy fill data inherently lack information on medication indication, but have been extensively used for pharmacoepidemiology studies in the KTx and living donor populations 28–32 . Patterns were robust in sensitivity analysis of patients with pretransplant diabetes.…”