Utilization of antihypertensive drugs among chronic kidney disease patients: Results from the Chinese cohort study of chronic kidney disease (C‐STRIDE)

Abstract

The utilization of antihypertensive drugs plays an important role in blood pressure control among chronic kidney disease (CKD) patients. Limited information was available on how antihypertensive drugs were used among Chinese CKD patients. In the present study, the utilization of antihypertensive drugs among a subgroup of hypertensive participants with a complete record of antihypertensive drug information from the Chinese Cohort Study of Chronic Kidney Disease was analyzed. Among 2213 subjects, 61.7% and 26.5% had their blood pressure controlled to <140/90 mmHg and <130/80 mmHg, respectively. In total, 38.5% were on monotherapy. Of those patients who received combination therapy, 57.8% were treated with a two‐drug combination. Renin‐angiotensin system inhibitors (RASIs) were the most commonly prescribed drugs (71.2%). Only 10.2% of the patients were prescribed diuretics. After multivariable adjustment, participants taking RASI were more likely to have their blood pressure controlled to <140/90 mmHg (prevalence ratio (PR) 1.153, 95% confidence interval (CI): 1.071‐1.240). CKD stage 4 (PR 0.548, 95% CI: 0.434‐0.692) was associated with RASIs treatment. Additionally, diabetes (PR 1.498, 95% CI: 1.120‐2.004), albumin/creatinine ratio ≥300 mg/g (PR 1.547, 95% CI: 1.020‐2.344), and CKD stage 4 (PR 2.022, 95% CI: 1.223‐3.343) were associated with diuretic use. The results suggested that combination therapy, diuretics use in general, and utilization of RASIs in advanced CKD stage were insufficient in the current treatment of Chinese hypertensive CKD patients.

Utilization patterns of antihypertensive drugs in the management of hypertension among patients with chronic kidney disease at a tertiary hospital

“…Previous studies showed that most hypertensive patients with CKD require multiple combination therapy for their blood pressure control. 8 In the present study, fixed dose combinations were given to only 4% of patients. Fixed doses were found to be better than free doses combinations because they enhance and improve There was no significant difference between the prescription of CCBs, diuretics, ACEIs, β-blockers and ARBs among patients with and without albuminuria.…”

“…In accordance with our study, a previous study recorded similar results in which 73.5% of the patients were having uncontrolled hypertension. 8 This may be explained by the presence of multiple comorbidities that might interact to increase the difficulty of the hypertension treatment approach among those patients.…”

“…9 On the contrary, another study showed that ACIs and ARBs were the most commonly used drugs. 8 This issue may be due to the co-existence of multiple cardiac disorders including heart failure and myocardial infarction. β-blockers might be required as drugs of choice to treat those cardiac disorders.…”

Correlation between Degree of HT with Degree of Albuminuria in Non-dialysis Chronic Kidney Disease Patients at Hypertension Kidney Polyclinic Dr. Soetomo General Hospital

“…ACE inhibitors can reduce proteinuria and intraglomerular pressure, inhibiting the development of CKD (Muchtar et al, 2015). The study of Liu et al, 2019 stated that the majority of HT in CKD were given ARBs monotherapy or ACE inhibitors because they had kidney and cardiovascular protective effects. According to ISH, 2020, the first line of HT therapy is an ACE inhibitors or ARBs because it can control blood pressure and reduce albuminuria.…”

Evaluation of Drug Prescribing Trends and Drug-Drug Interactions among Chronic Kidney Disease Patients

“…In these conditions, rational drug therapy is extremely difficult because of the augmented risk of drug-associated problems that needs the proper attention for the complicated drug regimen with expert monitoring (Al-Ramahi, 2012;Oluyombo et al, 2017). Efficacy, economy, compliance, and adherence are taken into consideration in selecting the drug for curing patients suffering from CKD (Hill et al, 2016;Liu et al, 2020). Such patients are most of the time taking polypharmacy prescriptions and are more at risk of drug-drug interaction and adverse drug reactions.…”