Effect of Antihypertensive Drugs on Rapid Decline in Estimated Glomerular Filtration Rate in Japanese Patients with Chronic Kidney Disease

Rapid decline in estimated glomerular filtration rate (eGFR) is linked to increased mortality and morbidity in chronic kidney disease (CKD). Few studies have focused on the risk of rapid eGFR decline. This study evaluates the association between antihypertensive drug use, blood pressure (BP) levels, and rapid eGFR decline in Japanese CKD patients. Data from 100,746 Japanese individuals aged 40-74 years with CKD were analyzed. Rapid eGFR decline was defined as an annual reduction >25%. Logistic regression was used to assess associations between antihypertensive drug use, BP levels, and rapid eGFR decline, stratified by eGFR and urinary proteinuria. Rapid eGFR decline occurred in 5.8% of participants. Higher BP levels increased the risk compared to normal BP: high-normal + elevated BP (odds ratio [OR], 1.26; 95% CI: 1.12-1.41) and high BP (OR, 1.79; 95% CI: 1.59-2.02). Controlling BP to high-normal or elevated levels in patients receiving antihypertensives reduced this risk. Overall, antihypertensive drug users had approximately twice the risk of rapid eGFR decline compared to non-users. However, in proteinuric patients with preserved eGFR, the risk increase was lower (1.27 times) in the high-normal + elevated BP group compared to that in the overall cohort. The risk of rapid eGFR decline increased with increasing BP and decreased with controlling BP. Antihypertensive treatment was associated with a higher risk of rapid eGFR decline at all BP levels. For CKD patients with proteinuria, maintaining BP in the high-normal or elevated range may further mitigate this risk.