A new study from Tufts Medical Center researchers finds that patients who continue taking certain blood pressure medications after a decline in kidney function may have better long-term outcomes than those who stop.
The study, published in JAMA Network Open, examined renin-angiotensin system inhibitors (RASIs), a widely prescribed class of medications used to treat high blood pressure, heart failure and chronic kidney disease.
Researchers found that patients who discontinued these medications after a decline in kidney function faced a higher risk of death and progression to kidney failure compared with those who continued treatment.
“These findings highlight the potential risks of discontinuing RASI therapy when declines in kidney function, defined as a greater than 15% reduction in estimated glomerular filtration rate, occur after starting treatment,” said Mark J. Sarnak, MD, MS, senior author of the study, Chief, Nephrology at Tufts Medical Center and professor, Tufts University School of Medicine. “Our data suggest there is benefit to continuing these medications, with no clear signal of harm, even with these level of declines.”
Study highlights
The retrospective study analyzed data from 4,233 patients who experienced a decline in kidney function after starting RASI therapy.
Key findings include:
- About one-third of patients (33%) discontinued their medication
- Patients who stopped treatment had a 23% higher risk of death
- They also had a 74% higher risk of progressing to end-stage kidney disease
- There was no significant difference in major cardiovascular events or acute kidney injury between groups
Understanding the findings
RASIs, which include ACE inhibitors and angiotensin receptor blockers, are a cornerstone of treatment for several chronic conditions. A modest decline in kidney function after starting these medications is expected and typically reflects a temporary change in blood flow to the kidneys, rather than actual damage.
Despite clinical guidelines recommending continuation, the study found that discontinuation remains common in real-world practice.
“Our findings reinforce the importance of staying on these therapies when appropriate,” said Dr. Sarnak. “They play a critical role in protecting long-term kidney and cardiovascular health.”
The results align with emerging evidence for other kidney-protective therapies, where early changes in kidney function should be interpreted carefully and not automatically lead to stopping treatment.
Advancing kidney care through research
The study used advanced analytical methods to evaluate outcomes including mortality, kidney failure and cardiovascular events. Collaborators included researchers from the University of Manitoba and the University of California, San Francisco.
