Prevalence, Patterns of Treatment, and Control of Hypertension in Predialysis Patients with Chronic Kidney Disease

Abstract

Background/Aims: Data on the prevalence, treatment and control of hypertension in patients with advanced chronic kidney disease (CKD) are limited. This study aimed to examine the above factors in a cohort of predialysis patients. Methods: During a period of 4 months, we recorded information on blood pressure (BP), comorbidities, medications and related parameters of patients followed up in the Low-Clearance Clinic of our Department. Control rates of hypertension were calculated at two thresholds: <130/80 and <140/90 mm Hg. Univariate and multiple linear regression analyses were employed to assess factors associated with BP control. Results: In the population studied [n = 238, males 58.4%, age 66.21 ± 4.2 years (mean ± SD), estimated glomerular filtration rate 14.5 ± 4.8 ml/min/1.73 m²], the prevalence of hypertension was 95.0%. Treatment rate among hypertensives was at 99.1%. On average, 3.04 ± 1.32 antihypertensive drugs were used, ranging from 1 to 7 agents. BP control rates at the <130/80 and <140/90 mm Hg thresholds were 26.5% and 48.2%, respectively. The systolic goal was achieved in 31.0% and 50.4%, whereas the diastolic goal was achieved in 67.7% and 91.2% of patients, respectively. In multivariate analysis, only black race was independently and inversely related with hypertension control (β = –0.187, p = 0.030). No specific antihypertensive class showed independent associations with control. Conclusions: Hypertension is highly prevalent in predialysis CKD patients. An almost universal treatment, employing a multi-agent regime, can help towards improved rates of control. Systolic BP is the main barrier to successful control and black race is associated with poorer control rates.

Prevalence of Apparent Treatment-Resistant Hypertension among Individuals with CKD

“…In an analysis of 3612 participants in the Chronic Renal Insufficiency study, 83% of individuals with hypertension were taking at least two classes of antihypertensive medication, with 26% and 32% of participants taking antihypertensive medications from three and four or more classes, respectively (3). Consistent with this finding, 87% of 238 predialysis CKD patients in a recent study were taking at least two antihypertensive medications, with 34% of patients taking three antihypertensive medications and 33% of patients taking four or more antihypertensive medications (13). However, the prevalence of aTRH was not evaluated in these prior studies.…”

“…Furthermore, most people with CKD and hypertension take multiple classes of antihypertensive medication (3,13). In an analysis of 3612 participants in the Chronic Renal Insufficiency study, 83% of individuals with hypertension were taking at least two classes of antihypertensive medication, with 26% and 32% of participants taking antihypertensive medications from three and four or more classes, respectively (3).…”

Hypertension in Chronic Kidney Disease Part 1

“…23,24 Population studies with CBP measurements have shown hypertension prevalence around 70% to 80% in patients with stage 1 CKD, whereas in stages 4 and 5 before initiation of dialysis, this rate increases to >95%. 25,26 CBP measurements are less than ideal to guide hypertension treatment in CKD. They are misleading in a large proportion of patients because as much as 40% of those who are apparently normotensive by CBP turn out to be hypertensive by HBP.…”

Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

“…Meanwhile, authors worldwide agree that the prevalence of arterial hypertension in pre-dialysis CKD patients can reach from 43 to95% [12,13] and stands as an important risk factor for progression and cardiovascular disease [14]. Ambulatory blood pressure monitoring stands as an useful tool in arterial hypertension diagnosis protocol [15,16] and seems to be superior to home or office blood pressure monitoring due to a lower risk of masked or white-coat hypertension, although this fact remains controversial.…”