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Published on: July 3, 2013
Management of hypertension in patients developing end-stage renal failure
I Dasgupta1, R J Madeley, M A Pringle
1Renal Unit, Nottingham City Hospital, UK.
Insights
Hypertension management in patients with end-stage renal failure showed significant deviations from standards. Poor blood pressure control in many patients may have worsened their kidney disease progression.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Hypertension management is crucial for preventing chronic renal failure progression and cardiovascular complications in renal disease patients.
- Effective blood pressure control is a cornerstone of care for individuals with kidney disease.
Purpose of the Study:
- To assess the quality of hypertension management in patients initiating dialysis.
- To identify deviations from established hypertension guidelines in this patient cohort.
Main Methods:
- A retrospective review of medical records for 145 patients starting dialysis over 3 years.
- Independent assessment of anonymized data against British Hypertension Society guidelines.
- Analysis of blood pressure readings and care standards in detection, investigation, referral, and follow-up.
Main Results:
- 76.4% of patients were hypertensive before end-stage renal failure.
- Deviations from standards occurred in all care categories: detection (24.3%), investigation (29%), referral (22.4%), and follow-up (17%).
- Only 45% achieved the recommended diastolic blood pressure of 90 mmHg; 32% had poor control potentially impacting renal failure progression.
Conclusions:
- Significant gaps exist in hypertension management for patients with end-stage renal disease.
- Current practices require improvement to optimize blood pressure control and patient outcomes.
- New strategies are needed to address the identified deficiencies in care.
Abstract:
The benefits of treating hypertension include preventing or delaying the progression of chronic renal failure, and reducing the cardiovascular complications of patients with renal disease. We examined how well hypertension had been managed in all 145 patients from a single health district who started dialysis during a 3-year period. Data relating to management of hypertension, including all blood pressure readings, were obtained from their general practice and hospital case notes. The anonymized data were reviewed by two independent assessors against a set of standards based on the British Hypertension Society guidelines. There was close agreement between the assessors. Complete records were obtained in 98.5% of cases. Of the 145 patients, 107 (76.4%) were hypertensive before developing end-stage renal failure. There were departures from standards in all categories of care: 24.3% in detection/diagnosis, 29% in investigation, 22.4% in referring to a nephrologist, and 17% in follow-up. The British Hypertension Society recommended standard for diastolic blood pressure of 90 mmHg was achieved in only 45%. In 32%, the assessors independently concluded that poor blood pressure control might have affected adversely the progression of renal failure. New methods of dealing with these problems are required and possible approaches are discussed.
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