Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Teo, Boon Wee; Chua, Horng Ruey; Wong, Weng Fai; Haroon, Sabrina; Subramanian, Srinivas; Loh, Ping Tyug; Sethi, Sunil; Lau, Titus

doi:10.11622/smedj.2016089

Cited by 8 publications

(12 citation statements)

References 27 publications

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“…Similarly, the rate was 77.5% in the UK study . Additionally, in a study performed in Singapore, the utilization of RASIs was >70.0% in patients with CKD stages 3‐4 . Therefore, the decreased utilization of RASIs in patients with CKD stages 3 and 4 might contribute to the reduced control of hypertension among these patients in the present study.…”

Section: Discussionsupporting

confidence: 52%

“…Therefore, diuretics should be a rational choice for antihypertensive treatment for CKD patients. This was found to be the case in the CRIC study with 84%, 62.6% in the GCKD study, 65.7% in the MERENA study, and 43.8% in the Singapore study . In addition, most CKD patients displayed salt sensitive features in their hypertension, indicating that increased salt intake could aggravate fluid retention and BP elevation.…”

Section: Discussionmentioning

confidence: 79%

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Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C‐STRIDE)

Liu¹,

Wang²,

Wang³

et al. 2019

J of Clinical Hypertension

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The utilization of antihypertensive drugs plays an important role in blood pressure control among chronic kidney disease (CKD) patients. Limited information was available on how antihypertensive drugs were used among Chinese CKD patients. In the present study, the utilization of antihypertensive drugs among a subgroup of hypertensive participants with a complete record of antihypertensive drug information from the Chinese Cohort Study of Chronic Kidney Disease was analyzed. Among 2213 subjects, 61.7% and 26.5% had their blood pressure controlled to <140/90 mmHg and <130/80 mmHg, respectively. In total, 38.5% were on monotherapy. Of those patients who received combination therapy, 57.8% were treated with a two‐drug combination. Renin‐angiotensin system inhibitors (RASIs) were the most commonly prescribed drugs (71.2%). Only 10.2% of the patients were prescribed diuretics. After multivariable adjustment, participants taking RASI were more likely to have their blood pressure controlled to <140/90 mmHg (prevalence ratio (PR) 1.153, 95% confidence interval (CI): 1.071‐1.240). CKD stage 4 (PR 0.548, 95% CI: 0.434‐0.692) was associated with RASIs treatment. Additionally, diabetes (PR 1.498, 95% CI: 1.120‐2.004), albumin/creatinine ratio ≥300 mg/g (PR 1.547, 95% CI: 1.020‐2.344), and CKD stage 4 (PR 2.022, 95% CI: 1.223‐3.343) were associated with diuretic use. The results suggested that combination therapy, diuretics use in general, and utilization of RASIs in advanced CKD stage were insufficient in the current treatment of Chinese hypertensive CKD patients.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 79%

Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C‐STRIDE)

Liu¹,

Wang²,

Wang³

et al. 2019

J of Clinical Hypertension

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“…It has been recognized that target SBPs are harder to attain in older participants in whom widening of pulse pressure may occur when diastolic blood pressure levels are lowered in the course of treatment. [34] Since patients with CKD tend to be older and have more cardiovascular risk factors, it is advisable to individualize treatment in patients according to their age and comorbidities.…”

Section: Management Of Hypertension In Ckd General Rulesmentioning

confidence: 99%

“…The KDIGO 2012 guidelines recommend a target blood pressure of <130/80 mmHg for patients with albuminuria. [34] In post hoc and subgroup analyses of the modification of diet in renal disease (MDRD) and The African-American Study of Kidney Disease and Hypertension (AASK) studies, a target MAP of 92 mmHg was associated with a slower decline in kidney function in patients with proteinuria of >0.3-1 g/day. [35,36] The Steno-2 study showed a reduced risk of cardiovascular disease with a blood pressure target of 130/80 mmHg compared to 135/85 mmHg in patients with Type 2 diabetes and microalbuminuria.…”

Section: Ckd With Proteinuriamentioning

confidence: 99%

Contribution of Hypertension to Chronic Kidney Disease

Leong¹,

Chua²,

Khatri³

2018

johtn

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Hypertension is one of the most prevalent chronic diseases worldwide and is a major risk factor for a decline in kidney function in patients with diabetic and non-diabetic kidney diseases. Conversely, patients with chronic kidney disease (CKD) inevitably develop hypertension during the course of the disease. Hypertension causes loss of autoregulation of afferent arterioles which leads to transmission of high systemic blood pressure to the glomeruli resulting in glomerular ischemia and subsequently glomerulosclerosis. Achieving optimal blood pressure control remains an integral component in the care of managing patients with CKD and is relevant at all stages of the disease irrespective of the underlying etiology. Blood pressure targets should be individualized based on age, comorbidities, and presence of proteinuria. Lifestyle changes notably sodium restriction should be implemented in all patients in addition to the antihypertensive therapy. Blockers of the renin-angiotensin-aldosterone system should be the agents of choice in the treatment of hypertension in CKD because of their antiproteinuric and renoprotective effect.

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“…[3] Besides diagnosis, even with good follow-up and access to medical care, hypertension may not be adequately controlled with current clinical practice and therapeutic drugs. [4] Perhaps, newer technologies such as retinal photography with computerized evaluation, it is possible to quantitatively assess the changes of blood vessels in hypertensive patients, particularly the adequacy of therapy. [5] Without higher fidelity assessment and follow-up, the residual risks of treated hypertension on mortality and complications cannot be completely eliminated.…”

mentioning

confidence: 99%

Hypertension in Asia

Teo¹

2018

johtn

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that improve the capture of ethnic or cultural factors affecting sodium intake and have simple and cheaper methods of assessing sodium intake. [7] Moreover, in specific Asian patient populations, we need to assess and quantify the utility of instruments helpful for managing hypertension. [8] This is because many of the devices and reference ranges were developed from patient populations in North American or European populations, and therefore, the bias and method of application are not immediately apparent in Asian patients. There is much work for hypertensionologists in Asia. Nonetheless, in this issue of the journal, we bring attention to hypertension and its association with other chronic "diseases" such as dyslipidemia and obesity. We will examine the other methods of assessing blood pressure such as retinal photography and central aortic pressure assessments and discuss some of the findings and work of Asian scientists and clinicians.

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Blood pressure and antihypertensive medication profile in a multiethnic Asian population of stable chronic kidney disease patients

Cited by 8 publications

References 27 publications

Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C‐STRIDE)

Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C‐STRIDE)

Contribution of Hypertension to Chronic Kidney Disease

Hypertension in Asia

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