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Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect Hypertensive Patients against Dialysis Risk
- Source :
- PLoS ONE, PLoS ONE, Vol 11, Iss 9, p e0162588 (2016)
- Publication Year :
- 2016
- Publisher :
- Public Library of Science, 2016.
-
Abstract
- Background Taiwan has the highest renal disease incidence and prevalence in the world. We evaluated the association of statin and renin–angiotensin system inhibitor (RASI) use with dialysis risk in hypertensive patients. Methods Of 248,797 patients who received a hypertension diagnosis in Taiwan during 2001–2012, our cohort contained 110,829 hypertensive patients: 44,764 who used RASIs alone; 7,606 who used statins alone; 27,836 who used both RASIs and statins; and 33,716 who used neither RASIs or statins. We adjusted for the following factors to reduce selection bias by using propensity scores (PSs): age; sex; comorbidities; urbanization level; monthly income; and use of nonstatin lipid-lowering drugs, metformin, aspirin, antihypertensives, diuretics, and beta and calcium channel blockers. The statin and RASI use index dates were considered the hypertension confirmation dates. To examine the dose–response relationship, we categorized only statin or RASI use into four groups in each cohort: 365 cumulative defined daily doses (cDDDs). Results In the main model, PS-adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for dialysis risk were 0.57 (0.50–0.65), 0.72 (0.53–0.98), and 0.47 (0.41–0.54) in the only RASI, only statin, and RASI + statin users, respectively. RASIs dose-dependently reduced dialysis risk in most subgroups and in the main model. RASI use significantly reduced dialysis risk in most subgroups, regardless of comorbidities or other drug use (P < 0.001). Statins at >365 cDDDs protected hypertensive patients against dialysis risk in the main model (aHR = 0.62, 95% CI: 0.54–0.71), regardless of whether a high cDDD of RASIs, metformin, or aspirin was used. Conclusion Statins and RASIs independently have a significant dose-dependent protective effect against dialysis risk in hypertensive patients. The combination of statins and RASIs can additively protect hypertensive patients against dialysis risk.
- Subjects :
- Male
medicine.medical_treatment
030232 urology & nephrology
lcsh:Medicine
Blood Pressure
030204 cardiovascular system & hematology
Pharmacology
Biochemistry
Vascular Medicine
Renin-Angiotensin System
0302 clinical medicine
Endocrinology
Chronic Kidney Disease
Medicine and Health Sciences
lcsh:Science
Aspirin
Multidisciplinary
Hazard ratio
Drugs
Middle Aged
Lipids
Metformin
Antihypertensive Drugs
Neurology
Nephrology
Cohort
Hypertension
Female
medicine.drug
Research Article
Adult
medicine.medical_specialty
Statin
medicine.drug_class
Endocrine Disorders
Cerebrovascular Diseases
Taiwan
03 medical and health sciences
Renal Dialysis
Internal medicine
Diabetes mellitus
Medical Dialysis
medicine
Diabetes Mellitus
Humans
Dialysis
Aged
Dose-Response Relationship, Drug
business.industry
lcsh:R
Statins
Biology and Life Sciences
medicine.disease
Confidence interval
Metabolic Disorders
lcsh:Q
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 11
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....9cd91061a483f887b89dd60b5ff151bc