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2016 ; 11
(9
): e0162588
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Statins and Renin Angiotensin System Inhibitors Dose-Dependently Protect
Hypertensive Patients against Dialysis Risk
#MMPMID27632175
Liu JC
; Hsu YP
; Wu SY
PLoS One
2016[]; 11
(9
): e0162588
PMID27632175
show ga
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: <28
(nonusers), 28-90, 91-365, and >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.
|*Renal Dialysis
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Dose-Response Relationship, Drug
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration &
dosage/*therapeutic use
[MESH]
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