Use of antihypertensive medications and mortality of patients with autosomal dominant polycystic kidney disease: a population-based study.

This study aimed to estimate the association between antihypertensive therapy and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Cohort study. Participants with ADPKD from the UK General Practice Research Database older than 15 years between 1991 and 2008. Use of 5 major classes of antihypertensive drug. Deaths, new renal replacement therapy events. Random-effects Poisson models were adjusted for age, sex, year of entry into the cohort, calendar year, prevalent coronary heart disease, stroke, diabetes, hyperlipidemia, and lipid-lowering therapy. From 1991-2008, there were 2,085 cases of ADPKD, with 1,877 contributing person-time for ages older than 15 years. In 1991, antihypertensive drugs were not prescribed for 68% of participants, which decreased to 38% by 2008. The proportion for which 1 class of antihypertensive drug was prescribed increased from 19% in 1991 to 24% in 2008; 2 classes, from 11% to 22%; 3 classes, from 2% to 11%; and 4 or 5 classes, from 1% to 5%. In 1991, drugs acting on the renin-angiotensin system were prescribed for only 7% of participants; by 2008, this had increased to 46%. There was evidence of a trend toward decreasing mortality as the number of antihypertensive drug classes prescribed in a year increased. For participants with 3 classes of drugs prescribed, the incident rate ratio was 0.11 (95% CI, 0.05-0.21; P < 0.001). Each annual increment in year of entry into the cohort was associated with a 6% (95% CI, 2%-10%; P = 0.008) decrease in mortality. Reported associations might be accounted for by unmeasured or incompletely measured confounders. These might include changes in other aspects of medical care for patients with ADPKD. Increasing coverage and intensity of antihypertensive therapy is associated with decreasing mortality in people with ADPKD. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.