Department of Research & Evaluation News

A Kaiser Permanente Southern California study showed that 1 heart-failure medication worked best among the 3 most commonly used to prevent illness and disease among patients with chronic kidney disease and heart failure.

“Beta blockers save lives in heart failure patients, but we wanted to see how this worked among patients who also had chronic kidney disease,” said the senior author John Sim, MD. Dr. Sim is a nephrologist at the Kaiser Permanente Los Angeles Medical Center and a clinician researcher with the Kaiser Permanente Southern California Department of Research & Evaluation. “This study demonstrated that bisoprolol, which is our beta blocker, is associated with better outcomes among these patients.”

Beta blockers are medications that lower heart rate and blood pressure by blocking the release of the stress hormones adrenaline and noradrenaline in certain parts of the body. This slows the heart rate and reduces the force at which blood is pumped around a person’s body. Three guideline-recommended beta blockers have been shown to reduce death and illness among patients with heart failure: bisoprolol, carvedilol, or metoprolol succinate. All are generic. While all beta blockers affect heart rate and blood pressure, non-selective beta blockers (e.g., carvedilol) have greater blood pressure effects compared to selective beta blockers (e.g., bisoprolol, metoprolol succinate) due to the types of receptors they target

The study was published in the Clinical Journal of the American Society of Nephrology in September, 2024. The study cohort included 1,842 Kaiser Permanente Southern California patients with advanced chronic kidney disease and heart failure. They received 1 of the 3 types of beta blockers. Researchers studied the patients’ electronic health records for the year after they developed advanced chronic kidney disease to see which patients fared better and who suffered from heart attacks or strokes, required dialysis, or died.

The study found:

• Among patients on beta blockers at the time they developed advanced chronic kidney disease, bisoprolol was associated with a 24% lower risk of a major heart attack compared to carvedilol after 1 year.
• No difference was seen in worsening kidney disease. But that may be because follow-up was only a year and it can take longer for kidney disease to worsen.
• There were not enough patients receiving metoprolol succinate to draw conclusions regarding its use.

“This is one of the first studies to examine this topic of the effectiveness of beta blockers among patients with chronic kidney disease and heart failure,” said the study’s lead author, Cheng-Wei “Charlie” Huang, MD, a hospitalist at the Los Angeles Medical Center and a clinician researcher with the Department of Research & Evaluation. “While all 3 beta blockers are approved for use to improve outcomes in heart failure, our study suggests that they may behave differently among patients with CKD and heart failure.”

In addition to Dr. Huang and Dr. Sim, other authors on their research included Albert Yu, MD, of the Los Angeles Medical Center; Hui Zhou, PhD; Katherine Pak, MS; Sally F. Shaw, DrPH; and Jiaxiao Shi, PhD, of the Department of Research & Evaluation; and Benjamin L. Broder, MD, PhD, of the Department of Quality and Clinical Analysis, Southern California Permanente Medical Group. Dr. Sim, Dr. Huang, and Dr. Zhou also on faculty withthe Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena.