Drugs that help lower blood pressure may reduce the risk of early death for people with advanced kidney disease, a new study finds.
The drugs could also lower patients' odds of requiring dialysis, the researchers said.
The new study out of Taiwan focused on two types of high blood pressure drugs, angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs).
ACE inhibitors have long been a standby of blood pressure care, and include drugs such as Altace (ramipril), Vasotec (enalapril) and Lotensin (benazepril, among others). ARB medications are also used to lower blood pressure, and include medications such as Atacand (candesartan), Cozaar (losartan), and valsartan (Diovan, among others).
Both classes of drugs have been known to delay the progression of chronic kidney disease in patients with and without diabetes, the Taiwanese authors noted. However, most large studies of ACE inhibitors or ARBs have excluded patients with advanced chronic kidney disease, so it hasn't been known how these drugs affect this group of patients.
So, this new study included nearly 28,500 advanced chronic kidney disease patients with stable high blood pressure. During a follow-up of seven months, nearly 71 percent of the patients had to begin dialysis and 20 percent died before reaching that stage.
Patients who took an ACE inhibitor or an ARB had a 6 percent lower risk of dialysis or death than those who didn't take the drugs, according to the study published online Dec. 16 in the journal JAMA Internal Medicine.
"In conclusion, our findings expand the existing knowledge in the field and provide clinicians with new information," wrote Dr. Ta-Wei Hsu, of the National Yang-Ming University Hospital, and colleagues.
Dr. Sripal Bangalore is an assistant professor in the division of cardiology at NYU Langone Medical Center, in New York City. He said the study was long needed, because this type of patient has been "largely excluded from randomized trials."
The finding that these blood pressure medications can lower risks to patients is "a message often preached by nephrologists [kidney specialists], but rarely followed by others," Bangalore added.
He stressed, however, that the study is observational and cannot prove that the use of these medications caused the improvement in outcomes.
Still, "the important take-home message is that these agents potentially can delay the need for dialysis," Bangalore said, "but one should carefully follow these patients for hyperkalemia [an unhealthy build-up of potassium in the kidneys]."
-- Robert Preidt
