Effectiveness of antihypertensive treatment in chronic renal failure: to what extent and with which drugs do patients treated by nephrologists achieve the recommended blood pressure?

Abstract

Adequate control of blood pressure (BP) is important to slow the progression of chronic renal failure (CRF). The Joint National Committee (JNC) VI recommends BP o130/85 mmHg, or o125/75 mmHg if urinary protein excretion exceeds 1 g/d. Angiotensin converting enzyme inhibitors (ACE-I) are considered as first-line agents. The current study is a survey of the degree of goal achievement and prescription patterns of antihypertensive (AHT) medication according to the JNC guidelines in clinical nephrology practice. All patients with CRF, not on renal replacement therapy, treated by nephrologists at the University Hospital of North-Norway were included in this retrospective cross-sectional study. Data on protein:creatinine ratio (PC ratio), BP and AHT drugs prescribed were extracted from the hospital's databases and medical records. A total of 144 patients were included. The patients' age was 62716 years and the serum creatinine value was 210792 lmol/l (mean7s.d.). In all, 74 patients (51%) had PC ratio p1, 36 (25%) 41, and for 34 (24%) PC ratio had not been measured; 23 (31%) of the patients with PC ratio p1 had BP p130/85 (139721/78712), and 5 (14%) of those with PC ratio 41 had BP p125/75 (145722/85714). Failure to achieve the goal was most commonly due to elevated SBP. In all, 55 % of the patients were prescribed ACE-I or angiotensin receptor blocker (ARB). In conclusion, the recommended BP goals may be difficult to achieve for a high proportion of patients in clinical practice due to difficulty in lowering SBP. There is a potential for improved treatment of hypertension in CRF patients, including increased prescription of ACE-I and ARB.

Improving Antihypertensive Agent Selection to Promote Nephroprotection

“…Patients with chronic renal failure treated by nephrologists in Norway were surveyed [103] to determine control of blood pressure to recommended levels and with which drugs. In 51% of patients the protein:creatinine ratio was <1; in 25%, >1; and in 24% of patients the protein:creatinine ratio was not determined.…”

A Persian Adaptation of Medication Adherence Self-Efficacy Scale (MASES) in Hypertensive Patients: Psychometric Properties and Factor Structure

“…Despite active and intensive drug treatment and increased awareness, the blood pressure in hypertensive patients is still poorly controlled in many countries [6]. Poor adherence to anti-hypertensive treatment has been shown to significantly contribute to the failure to achieve the goals of blood pressure management in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, which is unfortunately a global phenomenon [7]. Even with the access to effective anti-hypertensive medications, more than half of the patients spontaneously stopped their medication within the first year after the treatment initiated.…”

Elimination of Angiotensin – Converting Enzime Inhibitors by Peritoneal Dialisate

“…Angiotensin -converting enzyme (ACE) inhibitors represent significant group of drugs widely used in the treatment of hypertension, congestive heart failure and renal failure, especially in patients with diabetes mellitus and / or proteinuria. They were introduced in clinical practice three decades ago and today are the most commonly prescribed antihypertensive drugs (1).…”