Beta-blockers for coronary heart disease in chronic kidney disease.
BACKGROUND
Limited data exist on whether the cardioprotective benefit of beta-blockers is modified by the presence of chronic kidney disease (CKD).


METHODS
A post hoc analysis of the data from the Bezafibrate Infarction Prevention (BIP) study was performed. CKD was defined according to the Modification of Diet in Renal Disease (MDRD) equation as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m(2). The Cox proportional hazard model, including adjustment for propensity score, was used to estimate the hazard ratios (HR) for the composite endpoint combining acute myocardial infarction (AMI) or sudden cardiac death (SCD).


RESULTS
In this cohort of 3075 coronary heart disease (CHD) patients, 568 (18.5%) had CKD and 1185 (38.5%) were treated with beta-blockers. A total of 245 (43.1%) CKD patients received beta-blockers at baseline. The mean (+/- SD) estimated GFR in the CKD and non-CKD subgroups was 55 (+/- 4) and 73 (+/- 9) mL/min/1.73 m(2), respectively. After a median follow-up of 6.2 years, the crude incidence rates of AMI or SCD/1000 person years (PY) were 25.6, 21.9, 34.6 and 27.5 for the beta-blockers-/CKD-, beta-blockers+/CKD-, beta-blockers-/CKD+ and beta-blockers+/CKD+ groups, respectively. Compared to patients with beta-blockers-/CKD-, the adjusted HR of AMI or SCD was 0.87 (90% CI 0.71-1.06) for the beta-blockers+/CKD-, 1.35 (90% CI 1.05-1.73) for the beta-blockers-/CKD+ and 1.06 (90% CI 0.76-1.46) for the beta-blockers+/CKD+.


CONCLUSIONS
These analyses suggest that the use of beta-blockers is associated with a reduction in event risk in patients with CHD regardless of the presence or absence of CKD.
Chonchol
Michel
M
Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Box C-281, Denver, CO 80262, USA. Michel.Chonchol@uchsc.edu
Benderly
Michal
M
Goldbourt
Uri
U
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D023381:Endpoint Determination; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists