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Management of hypertension in patients with CKD: differences between primary and tertiary care settings

Roberto Minutolo1, Luca De Nicola, Pasquale Zamboli

  • 1Department of Nephrology, Second University of Naples, Naples, Italy. roberto.minutolo@unina2.it

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|June 29, 2005
PubMed

Insights

Blood pressure control is worse in primary care for patients with chronic kidney disease (CKD) compared to tertiary care. This is linked to fewer medications and less effective diuretic use, despite higher cardiovascular risk in primary care patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Primary Care Medicine

Background:

  • Most patients with moderate chronic kidney disease (CKD) are managed in primary care (PC).
  • Limited data exist on blood pressure (BP) control in this primary care setting.
  • This study compares hypertension management in CKD patients in PC versus nephrology tertiary care (TC).

Purpose of the Study:

  • To compare hypertension management and BP control in patients with moderate CKD.
  • To identify differences in BP control between primary care and tertiary care settings.
  • To investigate factors contributing to suboptimal BP control in primary care.

Main Methods:

  • Studied hypertensive patients with eGFR 15-60 mL/min/1.73 m2.
  • Compared patients exclusively followed in PC (n=259) versus TC (n=186) for at least 1 year.
  • Analyzed demographic data, cardiovascular history, eGFR, BP levels, and antihypertensive medication use.

Main Results:

  • PC patients were older, had higher cardiovascular risk and diabetes prevalence, and slightly higher eGFRs than TC patients.
  • PC patients exhibited higher BP levels and a significantly lower prevalence of achieving BP targets (5.8% vs 21.5%).
  • Fewer antihypertensive drugs were prescribed in PC, with differences in diuretic choice (hydrochlorothiazide in PC vs. furosemide in TC) and dosage.

Conclusions:

  • Hypertension control in CKD patients is significantly poorer in primary care compared to tertiary care.
  • Lower medication counts and inadequate diuretic therapy are likely barriers to optimal BP control in primary care.
  • These findings highlight the need for improved hypertension management strategies for CKD patients in primary care settings.
Abstract

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