Phosphate-lowering drug may increase blood pressure in patients with CKD
Click Here to Manage Email Alerts
Phosphate binder lanthanum carbonate increased systolic blood pressure in patients with chronic kidney disease, leading researchers to suggest the drug “may reduce gastrointestinal absorption of antihypertensive medications.”
“Serum phosphate concentrations rise as chronic kidney disease (CKD) progresses and higher concentrations are associated with vascular calcification, cardiovascular events, and all-cause mortality,” Mitra S. Jamshidian, MD, MS, of the University of California San Diego, and colleagues wrote. The relationship between serum phosphate and BP is less established, but emerging data suggest that higher levels may induce microvascular dysfunction and increase BP.”
To investigate, researchers used data from a randomized, double-blind, placebo-controlled trial that compared lanthanum carbonate with nicotinamide (an intestinal phosphate transport inhibitor) or double placebo (the latter two collectively referred to as the “non-lanthanum carbonate arm”). In total, 205 patients with CKD were randomized (at baseline, mean serum phosphate was 3.7 mg/dL; mean blood pressure was 129 mmHg/71 mmHg; 94% of patients took antihypertensive medications).
During a period of 12 months, researchers observed an increase in systolic blood pressure of 5 mmHg in patients who took lanthanum carbonate compared with non-users (the effect was seen within 3 months; no impact was observed on diastolic blood pressure).
“Given the widespread use of phosphate binders in CKD, the very high prevalence of hypertension, FDA warnings about co-administration of [lanthanum carbonate] LC with [angiotensin-converting-enzyme inhibitors] ACEI, and the large magnitude of change in [systolic blood pressure] SBP we observed, future studies to confirm these findings and determine the mechanisms should be a high priority,” Jamshidian and colleagues concluded.
Collapse
Read more about
Click Here to Manage Email Alerts