Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Viazzi, Francesca; Greco, Eulalia; Ceriello, Antonio; Fioretto, Paola; Giorda, Carlo; Guida, Pietro; Russo, Giuseppina; Cosmo, Salvatore De; Pontremoli, Roberto

doi:10.1159/000488255

Cited by 22 publications

(14 citation statements)

References 43 publications

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“…Notably, only 182 patients (1.20% among the hypertensive subjects) of the paper to which this commentary is devoted were treated with three or more antihypertensive drugs, including a diuretic and therefore defined patients with resistant hypertension. This figure is very different from that described from the AMD study group who in a large, real‐life cohort study in patients with type 2 diabetes and hypertension in Italy, from a total of 29 923 patients with normal baseline estimated glomerular filtration rate (eGFR) and of 2778 with stage 3 CKD, described a prevalence of 17% and 33% of resistant hypertension, respectively. This discrepancy is at least in part explained, as assessed by the authors, by the very low proportion of patients (2.7%) who are treated with more than two antihypertensive drugs in China …”

contrasting

confidence: 77%

We are far from achieving blood pressure goals in diabetes: Do we really want to do it?

Bonino

Viazzi

2019

J of Clinical Hypertension

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Diabetes is an emerging worldwide problem whose prevalence is expected to grow up. Microvascular and macrovascular complications have a great impact on quality of life and survival of patients and represent an economic and social burden. Current guidelines, regarding the blood pressure (BP) target in diabetic patients, point out the importance of a good BP control in order to prevent cardiovascular and renal complications. The 2013 European Society of Hypertension/ European Society of Cardiology (ESH/ESC) Task Force stopped recommending the target of <130/80 mm Hg in patients with diabetes and recommended a goal of <140/85 mm Hg 1 in partial accordance with that (<140/90 mm Hg) suggested by Eighth Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High BP (JNC 8). 2 Nevertheless, the latest 2018 Canadian hypertension guideline and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline have both recommended that adults with diabetes be treated to attain <130/80 mm Hg. 3,4 Recent studies show an alarming failure to achieve both glycemic and BP targets in a real-life scenario. In this issue of the Journal of Clinical Hypertension, the cross-sectional study by Yu-Qing Zhang and colleagues provides information on achievement in BP control in a cohort of 24 512 Chinese patients with type 2 diabetes in a realworld setting. 5 The CCMR-3B STUDY is an observational, cross-sectional, multicenter, and multispecialty study of diabetic outpatients conducted in 104 hospitals across major geographic regions in China. Only a minor proportion of this population reached the target BP values of 130/80 mm Hg (28.4%) recommended by Chinese diabetes guidelines. Among patients with hypertension (n = 15 211), 17.5% (n = 2658) achieved the recommended target BP, and 52.2% (n = 7936) had their BP controlled to <140/90 mm Hg. Interestingly, rural area and comorbidities such as obesity, hypertension, and chronic kidney disease (CKD) were associated with a lower goal of optimal BP. These data are in agreement with a recent nationwide report of the burden of hypertension across all 31 provinces in mainland China 6 describing as among the 105 379 subjects with diabetes, a 66% showed hypertension (BP levels above 140/90 mm Hg or antihypertensive treatment) and most were either not treated or treated inadequately. Taken together, these findings show that in China, despite the high prevalence of hypertension, awareness, treatment, and control are low across all population subgroups. Notably, only 182 patients (1.20% among the hypertensive subjects) of the paper to which this commentary is devoted 5 were treated with three or more antihypertensive drugs, including a diuretic and therefore defined patients with resistant hypertension. This figure is very different from that described from the AMD study group who in a large, real-life cohort study in patients with type 2 diabetes and hypertension in Italy, from a total of 29 923 patients with normal baseline estimated glomerular filtration ...

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confidence: 77%

We are far from achieving blood pressure goals in diabetes: Do we really want to do it?

Bonino

Viazzi

2019

J of Clinical Hypertension

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“…In this study, only 31% of patients reached systolic target while 69% of patients reached diastolic target (20). Treatmentresistant hypertension was found in 33% of CKD patients with DM (21). The least success rate was found in dyslipidemia treatment.…”

Section: Discussioncontrasting

confidence: 49%

The Compatibility of the Treatment Modalities to the Recommendations of the Kidney Disease Outcomes Quality Initiative Guideline in Chronic Kidney Disease Patients with Diabetes

Adibelli̇¹,

Duran²

2021

ijph

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Background: Diabetes mellitus (DM) and chronic kidney disease (CKD) are global growing health problems. Since DM is the major cause for CKD etiology, its development can be prevented with simple measures, like achievements of glycemic, lipid and blood pressure targets. This study aimed to evaluate whether the treatment goals for CKD patients with DM are achieved under the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline. Methods: Overall, 160 CKD patients with DM were enrolled in the study performed in Usak, Turkey from Jan 2016 to Jan 2018. Compatibility with treatment goals defined in KDOQI 2012 guideline for HbA1c levels, hypertension and dyslipidemia were evaluated retrospectively. Results: Of 160 CKD patients [15 (9.4%) in stage 3a, 53 (33.1%) stage 3b, 51 (31.9%) stage 4 and 41 (25.6%) stage 5], 23 patients in stage 5 were on hemodialysis. Total compliance rate to hyperglycemia treatment was 94 of 160 patients (58.8%). Compatibility rates between different stages of CKD were similar. Hypertension was detected only in 134 patients. Sixty-six (49.3%) patients were compatible with the treatment goals, and as the CKD stages progressed, the rate of patients achieving hypertension treatment goals was declined (P=0.001). One-hundred and thirty-seven patients were not on hemodialysis and fifty-four (39.9%) of 137 patients achieved dyslipidemia goal. There was no difference between different stages of CKD. Conclusion: Under KDOQI 2012 guideline, treatment goal for hyperglycemia was better achieved than the treatment goals for hypertension and dyslipidemia. In CKD patients with DM the physicians should be also focused on the treatment of hypertension and dyslipidemia.

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“…A final consideration is implementation of interventions that have been shown to be effective in trials into “real‐life” clinical practice. A number of observational studies have reported how this can be challenging, how there are differences between individuals in how easily treatment targets can be attained, and that failure to achieve treatment goals is associated with higher rates of DKD progression …”

Section: Treatment Goalsmentioning

confidence: 99%

An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines

Selby

Taal

2020

Diabetes Obesity Metabolism

417

240

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Diabetic nephropathy (DN) is a major healthcare challenge. It occurs in up to 50% of those living with diabetes, is a major cause of end-stage kidney disease (ESKD) that requires treatment with dialysis or renal transplantation, and is associated with significantly increased cardiovascular morbidity and mortality. DN is a clinical syndrome characterized by persistent albuminuria and a progressive decline in renal function, but it is increasingly recognized that the presentation and clinical course of kidney disease in diabetes is heterogeneous. The term diabetic kidney disease (DKD) is now commonly used to encompass the spectrum of people with diabetes who have either albuminuria or reductions in renal function. In this article, the clinical presentation and approach to diagnosis of DKD will be discussed, as will its prognosis. The general principles of management of DKD will also be reviewed with reference to current international guidelines.

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Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes

Cited by 22 publications

References 43 publications

We are far from achieving blood pressure goals in diabetes: Do we really want to do it?

We are far from achieving blood pressure goals in diabetes: Do we really want to do it?

The Compatibility of the Treatment Modalities to the Recommendations of the Kidney Disease Outcomes Quality Initiative Guideline in Chronic Kidney Disease Patients with Diabetes

An updated overview of diabetic nephropathy: Diagnosis, prognosis, treatment goals and latest guidelines

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