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Improvement of blood pressure control in hypertensive patients with renal diseases
Yuko Ohta1, Kazuhiko Tsuruya, Koji Fujii
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. yukoo@qmed.hosp.go.jp
Insights
Strict blood pressure control improved for hypertensive patients with renal disease after recent guidelines. Renal disease patients achieved lower blood pressure levels than those without renal disease.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Recent hypertension guidelines emphasize strict blood pressure (BP) control for patients with renal diseases (RD).
- Understanding current BP control status and changes post-guideline publication is crucial for optimizing patient care.
Purpose of the Study:
- To assess the current BP control status in hypertensive patients with and without RD.
- To evaluate changes in BP control before and after the publication of major hypertension guidelines.
Main Methods:
- A retrospective analysis of 489 hypertensive patients (with/without RD) visiting a specialized outpatient clinic.
- Comparison of BP levels and control rates between 1996 and 2003, analyzing prescription patterns of medications like angiotensin II receptor blockers (ARBs).
Main Results:
- In 2003, BP levels in RD patients were 134/78 mmHg, significantly lower than in 1996 (141/85 mmHg, p<0.05).
- The frequency of strict BP control (<130/80 mmHg) in RD patients increased from 11.8% in 1996 to 28.9% in 2003 (p<0.01).
- ARBs were more frequently prescribed to RD patients and their use increased significantly from 1996 to 2003.
Conclusions:
- Hypertensive patients with RD visiting the clinic showed improved BP control in recent years.
- BP levels in RD patients were lower than in non-RD patients, potentially reflecting increased physician awareness of strict BP control importance in RD.
Abstract:
For hypertensive patients with renal diseases (RD), strict blood pressure (BP) control has been recommended in recent hypertension guidelines, such as JNC VI, JNC 7, WHO/ISH 1999 and ESH-ESC 2003. We assessed the current status of BP control and the changes of BP control before and after the publication of these guidelines in 489 hypertensive patients with or without RD (age, 19-89 years, mean 59+/-13 years) who visited the hypertension and kidney outpatient clinic at Kyushu University Hospital. The clinical characteristics of RD and non-RD patients were assessed (RD patients: age, 20-89 years, mean 60+/-13 years, n=311; non-RD patients: age, 19-86 years, mean 58+/-13 years, n=178). In addition, we compared the BP control status in 2003 to that in 1996. In 2003, the BP in RD patients was 134+/-16/78+/-10 mmHg and that in non-RD patients was 138+/-12/83+/-9 mmHg. When strict BP control was defined as <130/80 mmHg, the frequency of strict BP control in RD patients was 28.9% in 2003. In addition, the BP levels of RD patients in 2003 were significantly lower than those in 1996 (134+/-16/78+/-10 mmHg vs. 141+/-17/85+/-10 mmHg, p<0.05 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]), and the frequency of strict BP control in RD patients was higher in 2003 than in 1996 (28.9% vs. 11.8%, p<0.01). The BP levels of non-RD patients in 2003 tended to be lower than those in 1996 (138+/-12/83+/-9 mmHg vs. 141+/-13/85+/-9 mmHg, n.s.). In 2003, angiotensin II receptor blockers (ARBs) were more frequently prescribed to RD patients than to non-RD patients. Furthermore, the use of ARBs was markedly increased in 2003 compared with 1996. In conclusion, in our outpatient clinic, BP levels in hypertensive patients with RD have improved in recent years, and were lower than those in hypertensive patients without RD, which may in part reflect the physicians' awareness of the importance of strict BP control in RD patients, as suggested by several recent hypertension guidelines.
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