Could a common blood pressure drug worsen kidney disease in type 2 diabetes?

• Both high blood pressure and chronic kidney disease are common complications of diabetes.
• If blood pressure is well controlled, this can help slow the progression of diabetic kidney disease.
• Several medications are used to control blood pressure, among them dihydropyridine calcium-channel-blockers (DCCBs).
• However, a new study suggests that this blood pressure treatment could speed up the progression of diabetic kidney disease in people with type 2 diabetes.

People with type 2 diabetes often also have hypertension (high blood pressure), which increases their risk of developing chronic kidney disease and kidney failure.

However, controlling blood pressure is effective in slowing the progression of kidney disease, as well as reducing the risk of cardiovascular events.

Dihydropyridine calcium-channel-blockers (DCCBs) are widely used as an extra therapy to treat hypertension in people with type 2 diabetes, alongside renin–angiotensin system inhibitors(RASi) and sodium–glucose cotransporter-2 inhibitors (SGLT2i).

Now, a study presented at the 63rd European Renal Association Congress in Glasgow, United Kingdom, suggests that DCCBs could be associated with poorer kidney outcomes in people with type 2 diabetes.

The research found that DCCB use was associated with a 33% higher risk of major adverse kidney events, when compared with other hypertension treatments used with people with type 2 diabetes.

These findings are yet to appear in a peer-reviewed journal.

The Association of British Clinical Diabetologists (ABCD) told Medical News Today:

“Treatment of hypertension is crucial in the management of diabetic kidney disease (DKD). Whilst treatment of hypertension with drugs that block the renin-angiotensin system (RAS) is of proven benefit in reducing progression of DKD, many patients require additional antihypertensive agents to achieve blood pressure targets. Dihydropyridine Calcium Channel Blockers (DCCB) are often used second or third line in many patients with DKD.”

“This data suggests that DCCBs may be associated [with] a more rapid progression of kidney disease in such patients. This is, of course, important and concerning. There may, however, be many confounders, and the findings need to be replicated in larger cohorts, ideally prospectively, before guidelines should be significantly changed,” they added.