Table 2.

Hazard ratios (95% confidence intervals) for kidney events, mortality, and cardiovascular events by class of antihypertensive medication added on to angiotensin-aldosterone system blockers compared with thiazide diuretics

Outcomesβ-BlockersCalcium Channel BlockersLoop Diuretics
Significant kidney events
 No. (total =21,897)734327052081
 No. of events (total =4707)1468511617
 Crude0.94 (0.88 to 1.00)0.88 (0.80 to 0.97)1.70 (1.55 to 1.87)
 Propensity score analysis0.81 (0.74 to 0.89)0.67 (0.58 to 0.78)1.19 (1.00 to 1.41)
 Propensity score analysis adjusting for current BP0.80 (0.73 to 0.88)0.63 (0.54 to 0.74)1.21 (1.01 to 1.44)
 Propensity score analysis adjusting for cumulative BP0.76 (0.69 to 0.84)0.60 (0.52 to 0.70)1.22 (1.03 to 1.46)
Mortality
 No. (total =21,897)734327052081
 No. of events (total =1498)595162364
 Crude2.18 (1.92 to 2.48)1.62 (1.34 to 1.94)5.35 (4.63 to 6.18)
 Propensity score analysis1.19 (0.97 to 1.44)0.73 (0.52 to 1.03)1.67 (1.31 to 2.13)
 Propensity score analysis adjusting for current BP1.13 (0.86 to 1.47)0.65 (0.43 to 0.99)1.61 (1.19 to 2.18)
 Propensity score analysis adjusting for cumulative BP1.13 (0.86 to 1.48)0.64 (0.42 to 0.98)1.62 (1.20 to 2.19)
Cardiovascular events
 No. (total =17,271)a459323201374
 No. of events (total =818)30110592
 Crude1.88 (1.61 to 2.20)1.31 (1.05 to 1.63)2.13 (1.69 to 2.69)
 Propensity score analysis1.65 (1.39 to 1.96)1.05 (0.80 to 1.39)1.55 (1.05 to 2.27)
 Propensity score analysis adjusting for current BP1.69 (1.42 to 2.01)1.06 (0.80 to 1.41)1.62 (1.12 to 2.35)
 Propensity score analysis adjusting for cumulative BP1.55 (1.30 to 1.85)1.00 (0.75 to 1.32)1.57 (1.08 to 2.27)
  • Reference group is thiazide diuretics. Significant kidney events were ≥30% eGFR decline from baseline and eGFR<60 ml/min per 1.73 m2, initiation of dialysis, or kidney transplant (Supplemental Table 1). Cardiovascular events were hospitalization for acute myocardial infarction, acute coronary syndrome, stroke, congestive heart failure, coronary artery bypass grafting, or percutaneous coronary intervention (Supplemental Table 1). Propensity score analyses were weighted using generalized stabilized inverse probability weights, with outcomes models including study site, age, sex, race, and variables with absolute standardized differences after propensity score weighting of ≥0.1. For the current BP adjustment, we adjusted for the mean BP each month as a time-varying covariate to capture any short-term BP effects. For the cumulative BP adjustment, we adjusted for the average of the monthly BP over all preceding months to capture any long-term BP effects.

  • a Excludes individuals with prevalent coronary artery disease, stroke, cardiac arrhythmias, or congestive heart failure at baseline.