Certain medications used to treat hypertension, called alpha-blockers, may be associated with a higher risk of progression of kidney disease when compared with other medication classes, according to a new study.* 

This research, published in the American Journal of Kidney Diseases, spurs the need for conversations between clinicians and patients about the impacts of medications on kidney health. 

In a recent article, Gregory L. Hundemer, MD, of the Ottawa Hospital Research Institute and The Ottawa Hospital, shared with Renal & Urology News that “nephrologists need to balance the pros and cons of prescribing alpha-blockers to their patients on a case-by-case basis.”

What they did

In the retrospective study, investigators looked at a database comprised of 381,120 patients, aged 66 years or older, who received treatment for hypertension from 2007 to 2015. The researchers pared this number down to 16,088 patients who were newly prescribed alpha-blockers. 

These medications include:

• Doxazosin
• Terazosin
• Prazosin

The alpha-blocker users were compared with another group of 16,088 patients, who were newly prescribed a different type of antihypertensive medication (not alpha-blockers), such as:

• ACE inhibitors
• Angiotensin receptor blockers
• Calcium channel blockers
• Beta blockers 
• Thiazide diuretics 

Patients were an average of 76 years old and had a mean estimated glomerular filtration rate (eGFR) of 62 mL/min/1.73m2. Patients with prior cardiac events were eliminated.

 The investigators looked at whether or not participants had:

• 30% or larger decline in eGFR
• Dialysis initiation or kidney transplantation
• Composite of acute myocardial infarction, coronary revascularization, congestive heart failure, or atrial fibrillation
• Safety events (hypotension, syncope, falls, fractures) 
• Mortality

What they found

The researchers found that the use of alpha-blockers was significantly associated with:

• 14% higher risk of a 30% or greater decline in eGFR
• 28% increased likelihood of dialysis initiation or kidney transplantation compared with the use of other medications for high blood pressure

The findings rang true regardless of initial eGFR. This is important because eGFR is an indicator of kidney health; when kidney health is compromised, eGFR levels decline.

A positive effect on cardiac events

While alpha-blockers negatively impact kidney health, they play a beneficial role, too. In this study, alpha-blockers decreased the risk of cardiac events in people of all eGFR levels—an 8% reduction in risk. In addition, the use of alpha-blockers “as significantly associated with a 15% and 29% decreased risk of death among patients with an eGFR of 30 to 59 and less than 30 mL/min/1.73 m2, respectively.”

It’s important to note the limitations of the study, as it was observational and lacked detailed blood pressure data. In addition, carvedilol, an alpha-beta blocker, was not incorporated in the study and should be looked at in future research.

What it means

While further research needs to be pursued on the topic, clinicians should take into account the findings of this research in their decision-making for their patients with both CKD and hypertension. 

Dr. Samuel N. Saltzberg, an associate professor of medicine at Rush Medical College in Chicago, Illinois, explained that “he has not observed a negative effect of alpha blockers among his patients with CKD, but it appears the effect described in the current study would not likely be seen or obvious in a smaller population.”

It’s important for physicians to weigh the benefits and risks of every medication they prescribe, as well as educate themselves on the contraindications to prevent further harm to people with CKD, an already vulnerable population.

*Schieszer, J. (2020, Oct. 19). Alpha Blockers Linked to Higher Risk for Kidney Disease Progression. Renal & Urology News. https://www.renalandurologynews.com/home/news/nephrology/hypertension/alpha-blocker-hypertension-blood-pressure-kidney-disease-cardiac-mortality/