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Abstract-Recent guidelines recommending more aggressive blood pressure control in patients with chronic kidney disease have unknown impact. We assessed trends in and predictors of blood pressure control in 8829 adult National Health 011]).With adjustment for demographic, socioeconomic, and clinical variables, older age (PϽ0.001) and lack of antihypertensive treatment (PϽ0.001) were associated with uncontrolled blood pressure, regardless of chronic kidney disease status; nonwhite race (Pϭ0.002) was associated in those without chronic kidney disease, whereas female sex (Pϭ0.030) was associated in those with chronic kidney disease. Multiple medications (PϽ0.001) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (Pϭ0.001) were associated with less uncontrolled blood pressure. Although some improvement has occurred over time, uncontrolled blood pressure remains highly prevalent, especially in subjects with chronic kidney disease and in nonwhites, older persons, and women. Therapy appears suboptimal. (Hypertension. 2009;54:47-56.) Key Words: blood pressure control Ⅲ prevalence Ⅲ trends Ⅲ risk factors Ⅲ treatment guidelines Ⅲ chronic kidney disease P ublished guidelines for blood pressure (BP) control include lower BP targets among those with chronic kidney disease (CKD) or diabetes mellitus 1,2 compared with those without these conditions. Lower BP is generally well known to be associated with decreased risk of kidney disease progression, cardiovascular events, and death. 3,4 Despite the recognized importance of controlling BP, control in the general population has been shown previously to be fairly poor, ranging from 29% to 60%, depending on age, sex, and race. [5][6][7] Similarly, patients with CKD have also been shown to have low rates of BP control. 6,8 -10 It has been shown that BP control increased from 1988 -1994 to 1999 -2004, 11 but whether BP control has improved over recent years is unclear. Moreover, factors that predict uncontrolled BP, including guideline-concordant care, are not well known in the setting of CKD.Previous studies of BP control in persons with CKD were generally performed within subpopulations or in a less representative cohort or screening studies.

Background and objectivesNephrotic syndrome (NS) represents a common disease in pediatric nephrology typified by a relapsing and remitting course and characterized by the presence of edema that can significantly affect the health-related quality of life in children and adolescents. The PROMIS pediatric measures were constructed to be publically available, efficient, precise, and valid across a variety of diseases to assess patient reports of symptoms and quality of life. This study was designed to evaluate the ability of children and adolescents with NS to complete the PROMIS assessment via computer and to initiate validity assessments of the short forms and full item banks in pediatric NS. Successful measurement of patient reported outcomes will contribute to our understanding of the impact of NS on children and adolescents.DesignThis cross-sectional study included 151 children and adolescents 8-17 years old with NS from 16 participating institutions in North America. The children completed the PROMIS pediatric depression, anxiety, social-peer relationships, pain interference, fatigue, mobility and upper extremity functioning measures using a web-based interface. Responses were compared between patients experiencing active NS (n = 53) defined by the presence of edema and patients with inactive NS (n = 96) defined by the absence of edema.ResultsAll 151 children and adolescents were successfully able to complete the PROMIS assessment via computer. As hypothesized, the children and adolescents with active NS were significantly different on 4 self-reported measures (anxiety, pain interference, fatigue, and mobility). Depression, peer relationships, and upper extremity functioning were not different between children with active vs. inactive NS. Multivariate analysis showed that the PROMIS instruments remained sensitive to NS disease activity after adjusting for demographic characteristics.ConclusionsChildren and adolescents with NS were able to successfully complete the PROMIS instrument using a web-based interface. The computer based pediatric PROMIS measurement effectively discriminated between children and adolescents with active and inactive NS. The domain scores found in this study are consistent with previous reports investigating the health-related quality of life in children and adolescents with NS. This study establishes known-group validity and feasibility for PROMIS pediatric measures in children and adolescents with NS.

To our knowledge we report the first randomized, controlled trial of BMP for preventing urinary incontinence in older women. It demonstrated feasibility and efficacy in improving continence status, pelvic muscle strength and voiding control as long as a year after treatment.