Antihypertensive medications and the risk of kidney stones in older adults: a retrospective cohort study.
Antihypertensives are widely prescribed and could influence kidney stone risk by altering urinary calcium excretion. However, the impact of different classes of antihypertensives on kidney stone risk is unknown. To assess this impact, we conducted a retrospective, population-based cohort study using linked health administrative databases. Individuals aged >65 years who initiated one of the four antihypertensive classes (that is, angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs), beta-blockers, calcium channel blockers or thiazide diuretics) were included. The participants were followed for the occurrence of a kidney stone event while maintaining continuous usage on their drug class. The association between antihypertensive class and outcome was estimated by Cox regression. Of the 542 581 people included, we observed 4533 kidney stone events (0.83%) over a median follow-up of 368 days (365-729). Compared with beta-blockers, thiazides were associated with a lower risk of kidney stones (hazard ratio (HR) 0.76; 95% confidence interval (CI) 0.68-0.84), ACEis/ARBs with a borderline decreased risk (HR 0.90; 95% CI 0.83-0.98) and calcium channel blockers with a comparable risk (HR 1.02; 95% CI 0.92-1.13). When the risk of requiring an intervention for a kidney stone was examined, the results were consistent with the primary analysis; however, the protective effect of ACEis/ARBs was eliminated (HR 0.96; 95% CI 0.87-1.06). In conclusion, relative to beta-blockers, thiazide diuretics were associated with a decreased risk of kidney stone formation in adults aged >65 years, whereas ACEis/ARBs and calcium channel blockers had a comparable risk of presenting with a kidney stone.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.|Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
R Todd
RT
Alexander
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Eric
E
McArthur
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Racquel
R
Jandoc
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Surgery, Western University, London, Ontario, Canada.|Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Blayne
B
Welk
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Jade S
JS
Hayward
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, Western University, London, Ontario, Canada.
Arsh K
AK
Jain
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Branko
B
Braam
Department of Pharmacology and Toxicology, Saarland University School of Medicine, Homburg, Germany.
Veit
V
Flockerzi
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.|Department of Medicine, Western University, London, Ontario, Canada.
Amit X
AX
Garg
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Robert Ross
RR
Quinn
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000139:chemically induced*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment
D000959:Antihypertensive Agents