Nl. Smith et al., THE ASSOCIATION OF ANTIHYPERTENSIVE MEDICATION WITH SERUM CREATININE CHANGES IN OLDER ADULTS, American journal of hypertension, 10(12), 1997, pp. 1368-1377
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.