Objective:
To investigate whether there is an association between use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB), and risk of acute kidney injury (AKI).
Design:
A time-updated, new-user cohort study among people initiating common antihypertensives (ACEI/ARB, beta-blockers, calcium channel blockers and thiazide diuretics) in primary care between April 1997 and March 2014.
Participants:
Adults initiating antihypertensive drug treatment, with at least one year of registration prior to first prescription, identified from UK primary care practices contributing to the Clinical Practice Research Datalink and eligible for linkage to hospital records data from the Hospital Episode Statistics database.
Main outcome measures:
Incidence rate ratio (RR) for first episode of AKI during time exposed to ACEI/ARB compared to time unexposed, estimated using Poisson regression adjusted for age, sex, comorbidities, use of other antihypertensive drugs, and calendar period.
Results:
Among 570,443 participants with a median follow-up of 2.8 years (IQR 0.4 to 7) there were 15,004 first cases of AKI. The overall crude rate of AKI was 6.4/1,000 person years at risk (95% CI 6.30 to 6.50) but varied from 1.63 (1.43 to 1.86) to 662.53 (538.98 to 814.40) depending on, age, comorbidities, and other prescribed drugs. The adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 1.18 (95% CI 1.13 to 1.23) which was attenuated to 1.12 (95% CI 1.08 to 1.17) after adjustment for non-thiazide diuretic therapy. There was an interaction for the risk of AKI between people using loop diuretics and ACEI/ARB. For those taking loop diuretics, the adjusted RR of AKI during time exposed to ACEI/ARB compared to time unexposed was 0.99 (95% CI 0.92 to 1.06) but it was 1.18 (95% CI 1.13 to 1.24) among people not-exposed to loop diuretics (p<0.001).
Conclusions:
Treatment with ACEI/ARB alone appears to be associated with a small increase in the rate of AKI which is largely seen among people with low absolute risk of AKI. Among people requiring loop diuretics, who have a high absolute risk of AKI, treatment with ACEI/ARB had no measurable association with AKI.
Kethryn E Mansfield, Dorothea Nitsch, Liam Smeeth, Krishnan Bhaskaram, Laurie A Tomlinson, Renin-angiostensin system blockage and risk of acute kidney injury. 2015.
Code | Description | Entity type | Category | Coding System (ICD-10 Read) |
---|---|---|---|---|
14A2.00 | h/o: hypertension | res30: Hypertension | diagnostic | Read |
1JD..00 | suspected hypertension | res30: Hypertension | diagnostic | Read |
2126100 | hypertension resolved | res30: Hypertension | diagnostic | Read |
212K.00 | hypertension resolved | res30: Hypertension | diagnostic | Read |
246M.00 | white coat hypertension | res30: Hypertension | diagnostic | Read |
662..12 | hypertension monitoring | res30: Hypertension | diagnostic | Read |
6624 | borderline hyperten:yearly obs | res30: Hypertension | diagnostic | Read |
6627 | good hypertension control | res30: Hypertension | diagnostic | Read |
6628 | poor hypertension control | res30: Hypertension | diagnostic | Read |
6629 | hypertension:follow-up default | res30: Hypertension | diagnostic | Read |
662F.00 | hypertension treatm. started | res30: Hypertension | diagnostic | Read |
662G.00 | hypertensive treatm.changed | res30: Hypertension | diagnostic | Read |
662H.00 | hypertension treatm.stopped | res30: Hypertension | diagnostic | Read |
662O.00 | on treatment for hypertension | res30: Hypertension | diagnostic | Read |
662P.00 | hypertension monitoring | res30: Hypertension | diagnostic | Read |
662P000 | hypertension 9 month review | res30: Hypertension | diagnostic | Read |
662b.00 | moderate hypertension control | res30: Hypertension | diagnostic | Read |
662c.00 | hypertension six month review | res30: Hypertension | diagnostic | Read |
662d.00 | hypertension annual review | res30: Hypertension | diagnostic | Read |
662q.00 | trial reduction of antihypertensive therapy | res30: Hypertension | diagnostic | Read |
662r.00 | trial withdrawal of antihypertensive therapy | res30: Hypertension | diagnostic | Read |
67H8.00 | lifestyle advice regarding hypertension | res30: Hypertension | diagnostic | Read |
7Q01.00 | high cost hypertension drugs | res30: Hypertension | diagnostic | Read |
7Q01y00 | other specified high cost hypertension drugs | res30: Hypertension | diagnostic | Read |
8B26.00 | antihypertensive therapy | res30: Hypertension | diagnostic | Read |
8BL0.00 | patient on maximal tolerated antihypertensive therapy | res30: Hypertension | diagnostic | Read |
8CR4.00 | hypertension clinical management plan | res30: Hypertension | diagnostic | Read |
8HT5.00 | referral to hypertension clinic | res30: Hypertension | diagnostic | Read |
8I3N.00 | hypertension treatment refused | res30: Hypertension | diagnostic | Read |
9N03.00 | seen in hypertension clinic | res30: Hypertension | diagnostic | Read |
9N1y200 | seen in hypertension clinic | res30: Hypertension | diagnostic | Read |
9N4L.00 | dna - did not attend hypertension clinic | res30: Hypertension | diagnostic | Read |
9OI..00 | hypertension monitoring admin. | res30: Hypertension | diagnostic | Read |
9OI..11 | hypertension clinic admin. | res30: Hypertension | diagnostic | Read |
9OI1.00 | attends hypertension monitor. | res30: Hypertension | diagnostic | Read |
9OI2.00 | refuses hypertension monitor. | res30: Hypertension | diagnostic | Read |
9OI3.00 | hyperten.monitor offer default | res30: Hypertension | diagnostic | Read |
9OI4.00 | hypertens.monitor.1st letter | res30: Hypertension | diagnostic | Read |
9OI5.00 | hypertens.monitor 2nd letter | res30: Hypertension | diagnostic | Read |
9OI6.00 | hypertens.monitor 3rd letter | res30: Hypertension | diagnostic | Read |
9OI7.00 | hypertens.monitor verbal inv. | res30: Hypertension | diagnostic | Read |
9OI8.00 | hypertens.monitor phone invite | res30: Hypertension | diagnostic | Read |
9OI9.00 | hypertens.monitor deleted | res30: Hypertension | diagnostic | Read |
9OIA.00 | hypertension monitor.chck done | res30: Hypertension | diagnostic | Read |
9OIA.11 | hypertension monitored | res30: Hypertension | diagnostic | Read |
9OIZ.00 | hypertens.monitoring admin.nos | res30: Hypertension | diagnostic | Read |
9h3..00 | exception reporting: hypertension quality indicators | res30: Hypertension | diagnostic | Read |
9h31.00 | excepted from hypertension qual indicators: patient unsuit | res30: Hypertension | diagnostic | Read |
9h32.00 | excepted from hypertension qual indicators: informed dissent | res30: Hypertension | diagnostic | Read |
F404200 | blind hypertensive eye | res30: Hypertension | diagnostic | Read |
F421300 | hypertensive retinopathy | res30: Hypertension | diagnostic | Read |
G2...00 | hypertensive disease | res30: Hypertension | diagnostic | Read |
G2...11 | bp - hypertensive disease | res30: Hypertension | diagnostic | Read |
G20..00 | essential hypertension | res30: Hypertension | diagnostic | Read |
G20..11 | high blood pressure | res30: Hypertension | diagnostic | Read |
G20..12 | primary hypertension | res30: Hypertension | diagnostic | Read |
G200.00 | malignant essential hypertension | res30: Hypertension | diagnostic | Read |
G201.00 | benign essential hypertension | res30: Hypertension | diagnostic | Read |
G202.00 | systolic hypertension | res30: Hypertension | diagnostic | Read |
G203.00 | diastolic hypertension | res30: Hypertension | diagnostic | Read |
G20z.00 | essential hypertension nos | res30: Hypertension | diagnostic | Read |
G20z.11 | hypertension nos | res30: Hypertension | diagnostic | Read |
G21..00 | hypertensive heart disease | res30: Hypertension | diagnostic | Read |
G210.00 | malignant hypertensive heart disease | res30: Hypertension | diagnostic | Read |
G210000 | malignant hypertensive heart disease without ccf | res30: Hypertension | diagnostic | Read |
G210100 | malignant hypertensive heart disease with ccf | res30: Hypertension | diagnostic | Read |
G210z00 | malignant hypertensive heart disease nos | res30: Hypertension | diagnostic | Read |
G211.00 | benign hypertensive heart disease | res30: Hypertension | diagnostic | Read |
G211000 | benign hypertensive heart disease without ccf | res30: Hypertension | diagnostic | Read |
G211100 | benign hypertensive heart disease with ccf | res30: Hypertension | diagnostic | Read |
G211z00 | benign hypertensive heart disease nos | res30: Hypertension | diagnostic | Read |
G21z.00 | hypertensive heart disease nos | res30: Hypertension | diagnostic | Read |
G21z000 | hypertensive heart disease nos without ccf | res30: Hypertension | diagnostic | Read |
G21z011 | cardiomegaly - hypertensive | res30: Hypertension | diagnostic | Read |
G21z100 | hypertensive heart disease nos with ccf | res30: Hypertension | diagnostic | Read |
G21zz00 | hypertensive heart disease nos | res30: Hypertension | diagnostic | Read |
G22..00 | hypertensive renal disease | res30: Hypertension | diagnostic | Read |
G22..11 | nephrosclerosis | res30: Hypertension | diagnostic | Read |
G220.00 | malignant hypertensive renal disease | res30: Hypertension | diagnostic | Read |
G221.00 | benign hypertensive renal disease | res30: Hypertension | diagnostic | Read |
G222.00 | hypertensive renal disease with renal failure | res30: Hypertension | diagnostic | Read |
G22z.00 | hypertensive renal disease nos | res30: Hypertension | diagnostic | Read |
G22z.11 | renal hypertension | res30: Hypertension | diagnostic | Read |
G23..00 | hypertensive heart and renal disease | res30: Hypertension | diagnostic | Read |
G230.00 | malignant hypertensive heart and renal disease | res30: Hypertension | diagnostic | Read |
G231.00 | benign hypertensive heart and renal disease | res30: Hypertension | diagnostic | Read |
G232.00 | hypertensive heart&renal dis wth (congestive) heart failure | res30: Hypertension | diagnostic | Read |
G233.00 | hypertensive heart and renal disease with renal failure | res30: Hypertension | diagnostic | Read |
G234.00 | hyperten heart&renal dis+both(congestv)heart and renal fail | res30: Hypertension | diagnostic | Read |
G23z.00 | hypertensive heart and renal disease nos | res30: Hypertension | diagnostic | Read |
G24..00 | secondary hypertension | res30: Hypertension | diagnostic | Read |
G240.00 | secondary malignant hypertension | res30: Hypertension | diagnostic | Read |
G240000 | secondary malignant renovascular hypertension | res30: Hypertension | diagnostic | Read |
G240z00 | secondary malignant hypertension nos | res30: Hypertension | diagnostic | Read |
G241.00 | secondary benign hypertension | res30: Hypertension | diagnostic | Read |
G241000 | secondary benign renovascular hypertension | res30: Hypertension | diagnostic | Read |
G241z00 | secondary benign hypertension nos | res30: Hypertension | diagnostic | Read |
G244.00 | hypertension secondary to endocrine disorders | res30: Hypertension | diagnostic | Read |
G24z.00 | secondary hypertension nos | res30: Hypertension | diagnostic | Read |
G24z000 | secondary renovascular hypertension nos | res30: Hypertension | diagnostic | Read |
G24z100 | hypertension secondary to drug | res30: Hypertension | diagnostic | Read |
G24zz00 | secondary hypertension nos | res30: Hypertension | diagnostic | Read |
G25..00 | stage 1 hypertension (nice - nat ins for hth clin excl 2011) | res30: Hypertension | diagnostic | Read |
G25..11 | stage 1 hypertension | res30: Hypertension | diagnostic | Read |
G26..00 | severe hypertension (nat inst for health clinical ex 2011) | res30: Hypertension | diagnostic | Read |
G26..11 | severe hypertension | res30: Hypertension | diagnostic | Read |
G27..00 | hypertension resistant to drug therapy | res30: Hypertension | diagnostic | Read |
G28..00 | stage 2 hypertension (nice - nat ins for hth clin excl 2011) | res30: Hypertension | diagnostic | Read |
G2y..00 | other specified hypertensive disease | res30: Hypertension | diagnostic | Read |
G2z..00 | hypertensive disease nos | res30: Hypertension | diagnostic | Read |
G672.00 | hypertensive encephalopathy | res30: Hypertension | diagnostic | Read |
G672.11 | hypertensive crisis | res30: Hypertension | diagnostic | Read |
Gyu2.00 | [x]hypertensive diseases | res30: Hypertension | diagnostic | Read |
Gyu2000 | [x]other secondary hypertension | res30: Hypertension | diagnostic | Read |
Gyu2100 | [x]hypertension secondary to other renal disorders | res30: Hypertension | diagnostic | Read |
L122.00 | other pre-existing hypertension in preg/childbirth/puerp | res30: Hypertension | diagnostic | Read |
L122000 | other pre-existing hypertension in preg/childb/puerp unspec | res30: Hypertension | diagnostic | Read |
L122100 | other pre-existing hypertension in preg/childb/puerp - deliv | res30: Hypertension | diagnostic | Read |
L122300 | other pre-exist hypertension in preg/childb/puerp-not deliv | res30: Hypertension | diagnostic | Read |
L122z00 | other pre-existing hypertension in preg/childb/puerp nos | res30: Hypertension | diagnostic | Read |
L127.00 | pre-eclampsia or eclampsia with pre-existing hypertension | res30: Hypertension | diagnostic | Read |
L127z00 | pre-eclampsia or eclampsia + pre-existing hypertension nos | res30: Hypertension | diagnostic | Read |
L128.00 | pre-exist hypertension compl preg childbirth and puerperium | res30: Hypertension | diagnostic | Read |
L128000 | pre-exist hyperten heart dis compl preg childbth+puerperium | res30: Hypertension | diagnostic | Read |
L128200 | pre-exist 2ndry hypertens comp preg childbth and puerperium | res30: Hypertension | diagnostic | Read |
TJC7.00 | adverse reaction to other antihypertensives | res30: Hypertension | diagnostic | Read |
TJC7z00 | adverse reaction to antihypertensives nos | res30: Hypertension | diagnostic | Read |
U60C500 | [x]oth antihyperten drug caus advers eff in therap use, nec | res30: Hypertension | diagnostic | Read |
U60C511 | [x] adverse reaction to other antihypertensives | res30: Hypertension | diagnostic | Read |
U60C51A | [x] adverse reaction to antihypertensives nos | res30: Hypertension | diagnostic | Read |
Code | Description | Entity type | Category | Coding System (ICD-10 Read) |
---|---|---|---|---|
I10 | essential (primary) hypertension | res30: Hypertension | diagnostic | ICD-10 |
I11 | hypertensive heart disease | res30: Hypertension | diagnostic | ICD-10 |
I11.0 | hypertensive heart disease with (congestive) heart failure | res30: Hypertension | diagnostic | ICD-10 |
I11.9 | hypertensive heart disease without (congestive) heart failure | res30: Hypertension | diagnostic | ICD-10 |
I12 | hypertensive renal disease | res30: Hypertension | diagnostic | ICD-10 |
I12.0 | hypertensive renal disease with renal failure | res30: Hypertension | diagnostic | ICD-10 |
I12.9 | hypertensive renal disease without renal failure | res30: Hypertension | diagnostic | ICD-10 |
I13 | hypertensive heart and renal disease | res30: Hypertension | diagnostic | ICD-10 |
I13.0 | hypertensive heart and renal disease with (congestive) heart failure | res30: Hypertension | diagnostic | ICD-10 |
I13.1 | hypertensive heart and renal disease with renal failure | res30: Hypertension | diagnostic | ICD-10 |
I13.2 | hypertensive heart and renal disease with both (congestive) heart failure and renal failure | res30: Hypertension | diagnostic | ICD-10 |
I13.9 | hypertensive heart and renal disease, unspecified | res30: Hypertension | diagnostic | ICD-10 |
I15 | secondary hypertension | res30: Hypertension | diagnostic | ICD-10 |
I15.0 | renovascular hypertension | res30: Hypertension | diagnostic | ICD-10 |
I15.1 | hypertension secondary to other renal disorders | res30: Hypertension | diagnostic | ICD-10 |
I15.2 | hypertension secondary to endocrine disorders | res30: Hypertension | diagnostic | ICD-10 |
I15.8 | other secondary hypertension | res30: Hypertension | diagnostic | ICD-10 |
I15.9 | secondary hypertension, unspecified | res30: Hypertension | diagnostic | ICD-10 |
I67.4 | hypertensive encephalopathy | res30: Hypertension | diagnostic | ICD-10 |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH575/version/1150/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH575/version/1150/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH575/version/1150/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH575/version/1150/export/codes/?format=json |
CSV | site_root/phenotypes/PH575/version/1150/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1150 | Hypertension | ieuan.scanlon | 2021-10-06 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
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