Antihypertensive medication use and change in kidney function in elderly adults: a marginal structural model analysis

Area of Science:

• Nephrology
• Geriatrics
• Pharmacology

Background:

• Limited evidence exists on antihypertensive medication effectiveness for slowing kidney function decline in older individuals.
• This study addresses the research gap using advanced statistical methods.

Purpose of the Study:

• To investigate the association between antihypertensive medication use and the rate of kidney function decline in hypertensive elderly individuals.
• To apply novel marginal structural models to account for confounding and informative censoring.

Main Methods:

• Utilized data from 1,576 hypertensive participants in the Cardiovascular Health Study (1989-1997).
• Measured kidney function change using cystatin C levels over 7 years.
• Employed a marginal structural model with a novel estimator to address potential biases.

Main Results:

• The average annual decline in estimated glomerular filtration rate (eGFR) was 2.41 mL/min/1.73 m(2).
• Marginal structural analysis indicated that antihypertensive therapy was associated with a slower eGFR decline (0.88-2.23 mL/min/1.73 m(2)/year).
• Adjusting for informative censoring strengthened the association between antihypertensives and preserved kidney function.

Conclusions:

• Antihypertensive therapy appears associated with preserved kidney function in hypertensive elderly adults.
• Findings suggest a potential benefit of blood pressure management in maintaining renal health in this population.
• Further confirmatory studies are recommended to validate these results.