Blood pressure management in hypertensive people with non-dialysis chronic kidney disease in Queensland, Australia

Abstract

Background High blood pressure is the most significant risk factor for the development and progression of chronic kidney disease (CKD). Lowering blood pressure is a goal to prevent CKD progression. This study of adults with CKD who have hypertension aimed to determine blood pressure control rates and the treatment patterns of hypertension and to explore factors associated with control of hypertension. Methods This cross-sectional study included all non-dialysis people with CKD stages 3A to 5 under nephrology care in three public renal clinics in Queensland, who joined the CKD.QLD registry from May 2011 to Dec 2015 and had a history of hypertension. Demographic information, other health conditions, laboratory markers and anti-hypertensive medications in use at consent were extracted from the registry. Results Among 1814 CKD people in these three sites in the registry who were age ≥ 18 years and had CKD stage 3A to 5, 1750 or 96% had a history of hypertension. Of these, the proportion with BP control to < 140/90 mmHg was 61.7% and to < 130/80 mmHg was 36.3%. With target BP < 140/90 mmHg or < 130/80 mmHg, participants aged ≥65 years were 1.23 (95% CI 1.06–1.42) or 1.12 (1.03–1.22) times more likely to have uncontrolled BP compared to those < 65 years old. Participants with severe albuminuria or proteinuria were 1.58 (1.32–1.87) or 1.28 (1.16–1.42, p < 0.001) more likely to have uncontrolled BP compared to those without significant albuminuria or proteinuria. Participants who had cardiovascular disease (CVD) were less likely to have uncontrolled BP compared to those without CVD (0.78, 0.69–0.89 or 0.86, 0.80–0.92). Factors associated with use of more classes of antihypertensive medicines among participants with uncontrolled BP (> 140/90 mmHg) were older age, diabetes, CVD, obesity and severe albuminuria/proteinuria ( p < 0.05). Renin Angiotensin Aldosterone System inhibitors were the most frequently used medicines, regardless of the number of medicine classes an individual was prescribed. Conclusions Blood pressure control rates in these hypertensive people with CKD was still far from optimal. People with CKD and hypertension aged 65 or older or with severe albuminuria or proteinuria, a group at risk of progression of kidney disease, have higher rates of uncontrolled BP.

Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam

“…The study found that 63.2% of the participants were incapable of controlling their BP less than 130/80 mmHg. This finding was consistent with previous studies that demonstrated the uncontrolled BP rates among NDCKD patients were in the range of 63.7%-64.8% (Zhang et al, 2019;Dharmapatni et al, 2020).…”

“…These factors were demonstrated to be positively associated with uncontrolled BP among general and hypertensive populations (Wang et al, 2018;Cherfan et al, 2020). By contrast, no association between these factors and uncontrolled BP was reported among patients with NDCKD (Schneider et al, 2018;Zhang et al, 2019). However, no study has been found to assess associations between these two factors and uncontrolled BP among patients with NDCKD in the Vietnam context.…”

Risk Factors for Progression of CKD with and without Diabetes

“…Our results were consistent with a recently published study, which found hypertension was an important risk factor for CKD progression to dialysis [ 50 ]. A cross-sectional study including 1814 CKD patients found that CKD patients with hypertension aged 65 or older, or with severe albuminuria or proteinuria, all of which put patients at risk of kidney disease, were found to have higher rates of uncontrolled BP [ 51 ]. It is important to keep blood pressure within the normal range.…”

Blood Pressure Control and Its Determinants among Patients with Non-Dialysis Chronic Kidney Disease in Myanmar

“…In spite of its benefits, BP control is not adequately practiced in this population. Previous studies have reported the poor rates of BP control at the recommended level (<130/80 mmHg) in patients with Non-Dialysis CKD (NDCKD) (Whelton et al, 2018), accounting for 10%-40% (Kuryata et al, 2019;Zhang et al, 2019;Zheng et al, 2020). Poor BP control can damage kidney function rapidly and eventually, lead to end-stage renal disease (ESRD).…”