CITATION:
Lopes AA, Bragg-Gresham JL, Ramirez SPB, Andreucci VE, Akiba T, Saito A, Jacobson SH, Robinson BM, Port FK, Mason NA, Young EW. Prescription of antihypertensive agents to hemodialysis patients: Time trends and associations with patient characteristics, country, and survival in the DOPPS. Nephrol Dial Transplant 2009; 24: 2809-2816
ABSTRACT:
BACKGROUND: Haemodialysis patients were studied in 12 countries to identify practice patterns of prescription of antihypertensive agents (AHA) associated with survival. METHODS: The sample included 28 513 patients enrolled in DOPPS I and II. The classes of AHA studied were beta blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), peripheral blocker, central antagonist, vasodilator, long-acting dihydropyridine calcium channel blocker (CCB), short-acting dihydropyridine CCB and non-dihydropyridine CCB. To reduce bias due to unmeasured confounders, the associations with mortality were assessed by separate Cox models based on patient-level prescription and facility prescription practice. RESULTS: An increase in prescription of ARBs (9.5%) and BBs (9.1%) was observed from DOPPS I to II. Prescription of AHA classes varied significantly by country, ranging for BBs from 9.7% in Japan to 52.7% in Sweden and for ARBs from 5.5% in Italy to 21.3% in Japan in DOPPS II. Facilities that treated 10% more patients with ARBs had, on average, 7% lower all-cause mortality, independent of patient characteristics and the prescription patterns of other antihypertensive medications (P = 0.05). Significant and independent associations with reduction in cardiovascular mortality were observed for ARBs (RR = 0.79; P = 0.005) and BBs (RR = 0.87, P = 0.004) in analyses of patient-level prescriptions. These associations in the facility-level model followed the same direction. CONCLUSIONS: DOPPS data show large variations across countries in AHA prescription for haemodialysis patients. The data suggest an association between ARB use and reduction in all-cause mortality, as well as with the use of BBs and reduction in cardiovascular mortality among haemodialysis patients.
|
|
The DOPPS Annual Report
The DOPPS Annual Report portrays descriptive statistics for multiple, representative cross-sectional cohorts over several practice areas, from anemia to vascular access.
|
DOPPS Presentations of Published Research
|
|
Coordinated by research scientists
and staff of Arbor Research Collaborative
for Health, and supported by research grants from Amgen (since 1996),
Kyowa Hakko Kirin (since 1999, in Japan), Genzyme (since 2009), and Abbott (since 2009) without
restrictions on publications.
|
|