Abstract:
Abstract
Background: The co-existence of diabetes with hypertension increases the risk of renal
dysfunction, and atherosclerotic cardiovascular outcomes. For preventing these consequences, an
appropriate combinations of antihypertensive agents are the main stay of therapy.
Objective: The primary aims of this study was to compare the effects of thiazide diuretics versus
Calcium Channel blockers on the renal events and associated factors after adding on Angiotensin
converting enzyme inhibitors among diabetic with hypertensive patients attending at the
University of Gondar hospital outpatient department from January 2015 to December 2019.
Methods: A hospital-based comparative retrospective cohort study was conducted from March 17
to June 19, 2020 on the medical records of diabetic with hypertension patients attended chronic
follow up clinic of UOGCSH between January 2015 and December 2019. Descriptive and
analytical statistics were utilized to illustrate comparisons in the study groups. Kaplan-Meier and
a log- rank test was used to plot the survival analysis curve. Potential predictors on the renal events
was examined using cox proportional hazards model. The significant renal function was defined
as reduction in eGFR levels by ?30% from the baseline. A 5% level of significance was used.
Result: A total of 404 patients were involved in the final analyses; and participants were recruited
with a 1:1 ratio. The mean eGFR levels (measured by ml/min/1.73m
VIII
2
) were significantly higher in
patients taking CCBs based regimens at the 2
nd
, 3
rd
and 5
th
years of the follow-ups with 6.92,
P=0.026; 9.5, P=0.018, and 18.02, P=0.005, respectively. The CCBs group had a median change
of 18.8ml/min/1.73m
2
higher in eGFR (last minus initial) at the end of the follow-up than HCT
group (P<0.001). The HCT users had a shorter survival probability overtime to develop the events
compared with CCBs group (X
2
=8.64; P=0.003). The CCBs based regimen prevented the risks
of declining in renal function by 56.3% than HCT (AHR (95% CI) = 0.437 (0.268-0.714),
P=0.001). The risks of declining in eGFR levels were 90.3% higher for the patients whose initial
SBP levels were more than 150mmHg (AHR (95% CI) = 1.902 (1.183-3.057), P=0.008).
Conclusion: Compared with HCT, patients on CCBs had a significantly lower risks of renal
events. However, both groups appeared with the same cardiovascular events. Hydrochlorothiazide
and higher initial SBP levels were significantly associated with eGFR reductions.
Key words: Ethiopia, Thiazide diuretics, calcium channel blockers, diabetes, hypertension
