Key Finding: Among adults with type 2 diabetes already on standard kidney-protective therapy, the use of a common class of blood pressure medication was linked to a 33% higher risk of major kidney complications.
Stockholm, Sweden – New research presented at the 63rd ERA Congress suggests that a widely used type of blood pressure medication may be associated with an increased risk of kidney disease progression in patients with type 2 diabetes.
Study Overview
The analysis examined data from 31,031 adults with type 2 diabetes treated between 2016 and 2021. All participants were already receiving the standard of care for kidney protection, including renin-angiotensin system (RAS) inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors.
Within this group:
- 12,172 patients (39.2%) were also taking a dihydropyridine calcium-channel blocker (DCCB).
- 18,859 patients (60.8%) were receiving other antihypertensive treatments.
- The median follow-up period for the study was approximately 3.5 years.
Core Finding: Elevated Kidney Risk
After adjusting for baseline differences between the groups, researchers found a significant difference in outcomes.
DCCB use was associated with a 33% higher risk of a major adverse kidney event (Hazard Ratio 1.33, 95% CI 1.03-1.73).
These events were defined as a ≥40% decline in estimated glomerular filtration rate (eGFR) or progression to end-stage kidney disease requiring dialysis or transplantation.
Potential Mechanism
Diabetic kidney disease (DKD) , a leading cause of kidney failure, occurs when high blood sugar damages the blood vessels in the kidneys. Controlling blood pressure is a cornerstone of treatment.
Lead author Dr. Timna Agur explained a potential reason for the observed association. DCCBs might increase pressure within the kidney’s filtering units by preferentially relaxing the afferent arterioles (the blood vessels entering the filters), potentially contributing to ongoing damage. Notably, this risk persisted even when patients were also taking SGLT2 inhibitors.
Important Caveat
The researchers emphasized that this is an observational study and cannot establish causation.
"This is an observational study and cannot establish causation. Further prospective studies and randomized trials are needed to confirm these findings and understand the underlying mechanisms." – Dr. Timna Agur and colleagues
The findings were presented at the 63rd ERA Congress and require further validation through rigorous prospective research.