A new study found that dihydropyridine calcium-channel blockers (DCCBs) — a widely used blood pressure medication — may be linked to worse kidney outcomes in people with type 2 diabetes (T2D), even when patients are already on modern kidney-protective drugs.
Study details:
- Data analyzed: 31,031 adults with T2D from 2016–2021, all taking both RAS inhibitors and SGLT2 inhibitors, the current standard kidney-protective therapies for diabetic kidney disease (DKD).
- Groups: 12,172 patients (39.2%) also took DCCBs; 18,859 (60%) took other antihypertensives.
- Follow-up: Median ~3.5 years.
Results: After adjusting for baseline differences, DCCB use was associated with a 33% higher risk of major adverse kidney events compared to other blood pressure treatments. These events included a ≥40% drop in eGFR or progression to end-stage kidney disease requiring dialysis/transplant.
Why this might happen: Researchers suggest DCCBs may worsen kidney damage by relaxing blood vessels entering the kidney’s filtering units but not those exiting, potentially increasing pressure and strain within the kidneys. The increased risk persisted even with SGLT2 inhibitors, which were thought to possibly offset harm.
Context:
- DKD is a leading cause of kidney failure worldwide, driven by high blood sugar damaging kidney blood vessels.
- DCCBs are commonly prescribed as second-line blood pressure meds for DKD patients.
- RAS and SGLT2 inhibitors are now standard of care for DKD due to their kidney-protective effects.
Researcher comments: Lead author Dr. Timna Agur noted the findings “raise important questions about whether these medications are always the best option” for DKD patients on modern therapies.
Caveats: The study is observational, so it cannot prove DCCBs directly cause worse outcomes. Dr. Agur called for prospective studies and randomized controlled trials to confirm results and define safest blood pressure strategies. Given how commonly DCCBs are prescribed, even a small risk increase could affect many DKD patients.