THE ASSOCIATION OF ANTIHYPERTENSIVE MEDICATION WITH SERUM CREATININE CHANGES IN OLDER ADULTS

Many of the potential effects of antihypertensive therapy, including r enal function, have been inadequately investigated in clinical trials in older adults.In an observational study, we examined the association between treatment with various classes of antihypertensive agents and 3-year changes in serum creatinine in 1296 older adults with treated hypertension and without prior renal disease (mean age 72.2 years; 60% female; 30% diabetic; 42% with cardiovascular disease (CVD)) from the Cardiovascular Health Study. Baseline antihypertensive medications in cluded thiazides (HCT), beta-adrenergic blockers, angiotensin converti ng enzyme inhibitors (ACE-I), calcium channel blockers (CCB), vasodila tors (VAS), HCT + BE, HCT + ACE-I, HCT + CCB, HCT + VAS, loop diuretic s (LOOP), and other combinations. Unadjusted results indicated that mi nimal changes in mean serum creatinine occurred over time for all ther apies and only a few changes were statistically significant (HCT: +0.0 2 mg/dL, ACE-I: +0.04, CCB: +0.04; all P < .05; LOOP: +0.06 mg/dL; P < .001). In multivariate analyses with HCT users as the reference group and adjusting for baseline serum creatinine, age, sex, smoking, diabe tes mellitus, CVD, height, weight, common carotid intima-media thickne ss, and use of allopurinol, phenytoin, cimetidine, and nonsteroidal an tiinflammatory drugs, all of the relative changes were small and stati stically nonsignificant except for HCT + VAS users (+0.07 mg/dL; P < . 05). When users of the same therapy at baseline and follow-up were res tricted, only LOOP users had significant albeit small changes in serum creatinine (+0.05 mg/dL; P < .05). Although results from clinical tri als are needed to confirm these findings, these observational data sug gest no major differences between specific antihypertensive therapies in 3-year serum creatinine changes in older adults without prior renal disease. (C) 1997 American Journal of Hypertension, Ltd.