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Hypertension control and antihypertensive therapy in patients with chronic kidney disease
Sudhir Unni1, Kellee White2, Michael Goodman3
1Pharmacotherapy Outcomes Research Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA; sudhir.unni@pharm.utah.edu.
Insights
Blood pressure control in chronic kidney disease (CKD) patients remains challenging. This study found that while multiple antihypertensive therapies improved blood pressure control, younger CKD patients were less likely to achieve treatment goals.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for chronic kidney disease (CKD) progression.
- Despite higher prevalence and treatment rates, blood pressure (BP) control is often suboptimal in CKD patients.
- Current guidelines advocate for multiple antihypertensive agents, but their effectiveness across CKD stages is not fully understood.
Purpose of the Study:
- To examine the relationship between the number and type of antihypertensive therapy and blood pressure control in patients with CKD stages 1-4.
- To identify factors associated with achieving target blood pressure levels in this population.
Main Methods:
- Cross-sectional analysis of a large electronic medical record (EMR) database.
- Inclusion of 115,608 patients with CKD (Stages 1-4) and hypertension.
- Blood pressure and antihypertensive therapy data extracted from EMR; estimated glomerular filtration rate calculated using the Cockcroft-Gault equation.
Main Results:
- Overall blood pressure control (defined as <130/80 mm Hg) was achieved in 24.3% of patients.
- BP control varied significantly by CKD stage and the number of antihypertensive therapies used.
- Younger age was inversely associated with BP control. Multiple antihypertensive therapy showed the strongest association with BP control in CKD Stage 2.
- Diuretic use was associated with lower odds of BP control in CKD Stages 1 and 2.
Conclusions:
- The study underscores the need for focused attention on achieving BP treatment goals, particularly for younger individuals with CKD.
- Further research is required to determine optimal antihypertensive drug combinations for effective BP management in CKD.
- Limitations include the unavailability of prescription fill data and medication adherence information.
Background:
Hypertension is a major risk factor in the progression of chronic kidney disease (CKD). Although hypertension is more prevalent and treated more often among CKD patients, it is less likely to be controlled. Current guidelines recommend the use of multiple antihypertensive agents to achieve optimal blood pressure (BP) control. However, BP control attained by number and type of antihypertensive therapy according to CKD stage has not been examined thoroughly.
Study Design:
Cross-sectional analysis of an electronic medical record (EMR) database.
Setting And Participants:
A total of 115,608 patients with CKD (Stages 1-4) and diagnosed or treated hypertension in General Electric Centricity EMR from 1996 to 2012.
Outcome:
BP control, based on JNC 7 guidelines, was defined as less than 130/80 mm Hg.
Measurements:
BP and antihypertensive therapy use was obtained from the EMR. The Cockcroft-Gault equation was used to calculate estimated glomerular filtration rate and classify CKD stage.
Results:
Overall prevalence of BP control was 24.3%. BP control varied by CKD stage and number of antihypertensive therapy. In multivariable analysis, younger age was less likely to be associated with BP control, regardless of CKD stage. Multiple antihypertensive therapy use and BP control was strongest among CKD Stage 2 (odds ratio (OR): 1.41; 95% confidence interval (CI): 1.05, 1.90). Diuretic use was less likely to be associated with BP control among CKD Stage 1 (OR: 0.71; 95% CI: 0.59, 0.87) and 2 (OR: 0.78; 95% CI: 0.72, 0.85).
Limitations:
Information on antihypertensive prescription fill data and adherence to medication regimens was unavailable.
Conclusions:
This study highlighted the need to pay closer attention to achieving BP treatment goals for younger individuals with CKD. More research is needed to assess the extent to which specific combinations of antihypertensive drugs leads to adequate BP control.
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