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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Hospital specific factors affect quality of blood pressure treatment in chronic kidney disease
A D van Zuilen1, P J Blankestijn, M van Buren
1Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands. a.vanzuilen@umcutrecht.nl
Insights
Hospital variations significantly impact blood pressure (BP) control in chronic kidney disease patients, even after accounting for patient and treatment factors. Physician approach differences likely explain these persistent BP control disparities between healthcare centers.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Blood pressure (BP) is a critical modifiable risk factor for cardiovascular disease and kidney dysfunction progression.
- Achieving adequate BP control in chronic kidney disease (CKD) patients remains challenging despite available antihypertensive treatments.
- Understanding determinants of BP control is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate differences in achieved BP and BP goal attainment among hospitals.
- To explore potential explanations for observed variations in BP control between hospitals.
Main Methods:
- Standardized BP measurements using an oscillometric device in 788 CKD patients.
- Analysis of baseline characteristics and last measured office BP from patient records.
- Univariate and multivariate analyses with general linear modeling, incorporating hospital as a random factor.
Main Results:
- Hospital was a significant determinant of baseline systolic and diastolic BP in univariate analysis.
- Even after adjusting for patient, kidney disease, and treatment characteristics, significant differences between hospitals persisted.
- A range of 15 mmHg for systolic BP and 11 mmHg for diastolic BP was observed between centers in the fully adjusted model.
Conclusions:
- Clinically relevant and statistically significant differences in standardized BP measurements exist between hospitals in CKD patients.
- These inter-hospital variations in BP control persist despite extensive statistical adjustments.
- Hypothesized physician-level differences in BP management approach may explain the observed hospital disparities.
Background:
Blood pressure (BP) is the most important modifiable risk factor for cardiovascular (CV) disease and progression of kidney dysfunction in patients with chronic kidney disease. Despite extensive antihypertensive treatment possibilities, adequate control is notoriously hard to achieve. Several determinants have been identified which affect BP control. In the current analysis we evaluated differences in achieved BP and achievement of the BP goal between hospitals and explored possible explanations.
Methods:
At baseline, BP was measured in a supine position with an oscillometric device in 788 patients participating in the MASTER PLAN study. We also retrieved the last measured office BP from the patient records. Additional baseline characteristics were derived from the study database. Univariate and multivariate analyses were performed with general linear modelling using hospital as a random factor.
Results:
In univariate analysis, hospital was a determinant of the level of systolic and diastolic BP at baseline. Adjustment for patient, kidney disease, treatment or hospital characteristics affected the relation. Yet, in a fully adjusted model, differences between centres persisted with a range of 15 mmHg for systolic BP and 11 mmHg for diastolic BP.
Conclusion:
Despite extensive adjustments, a clinically relevant, statistically significant difference between hospitals was found in standardised BP measurements at baseline of a randomised controlled study. We hypothesise that differences in the approach towards BP control exist at the physician level and that these explain the differences between hospitals.
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