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Clinical audit improves hypertension control in hemodialysis patients
Pasquale Esposito1, Attilio Di Benedetto, Carmine Tinelli
1Department of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy. pasqualeesposito@hotmail.com
Insights
A clinical audit effectively improved blood pressure (BP) control in hemodialysis (HD) patients. This audit reduced hypertension prevalence and medication use, demonstrating its value in managing BP for HD patients.
Area of Science:
- Nephrology
- Clinical Medicine
- Public Health
Background:
- Hypertension is a significant cardiovascular disease risk factor in hemodialysis (HD) patients.
- Effective blood pressure (BP) management is crucial for this population.
Purpose of the Study:
- To evaluate the effectiveness of a clinical audit in improving BP control among HD patients.
- To assess the impact of the audit on hypertension prevalence and antihypertensive medication use.
Main Methods:
- A prospective study involving 177 adult HD patients in Italian NephroCare centers.
- Data collection included BP, comorbidities, and anti-hypertensive drug regimens at baseline, audit, and 1 and 6 months post-audit.
- The primary outcome was reducing hypertension prevalence (BP ≥ 140/90 mmHg).
Main Results:
- At audit, 58.7% of patients were hypertensive; prevalence decreased to 47.6% at 6 months post-audit (p<0.05).
- Systolic BP significantly decreased in hypertensive patients post-audit (p<0.001).
- The number of anti-hypertensive drugs decreased significantly post-audit (p<0.001).
Conclusions:
- Clinical audit is a highly effective strategy for enhancing BP control in hemodialysis patients.
- Audits can lead to reduced hypertension prevalence and medication requirements.
Background:
In patients on hemodialysis (HD), hypertension is a risk factor for cardiovascular disease. In this study we tested the effectiveness of a clinical audit in improving blood pressure (BP) control in HD patients.
Methods:
177 adult, prevalent patients undergoing dialysis in NephroCare centers in Italy were audited. At the conclusion of the audit, individual strategies were developed in order to improve BP control. Patient data was collected and examined at months -1 (Pre), 0 (the date of the audit- Audit), and +1 and +6 after the audit (Post-1 and Post-6, respectively). We recorded BP, information on factors affecting BP, and anti-hypertensive drug regimen. The primary outcome of the study was to decrease prevalence of hypertension (BP ≥ 140/90 mmHg). Secondary outcomes were a reduction in average BP in hypertensive patients and/or a decrease in drug delivery associated with lower or unchanged BP.
Results:
104 patients out of 177 (58.7%) were hypertensive at Audit. BP levels were directly related to comorbidity and male sex, and inversely related to dialysate sodium concentration. The announcement of the audit alone was associated with a decreased prevalence of hypertension (Pre 64.4% to Audit 58.7%); a further decrease followed the audit (Post-1 51.1%, Post-6 47.6%, p<0.05 vs. Audit). Systolic BP in hypertensive patients also decreased (mean decrease was -8.5 and -14.1; p = 0.007 and p<0.001 at Post-1 and Post-6). Number of drugs assumed was significantly lower at Post-1 and Post-6 vs. Audit (p = 0.005 and p<0.001, respectively).
Conclusions:
A clinical audit is an effective tool to improve BP control in HD patients.
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