Nephrology Dialysis Transplantation, Vol 13, Issue 12 3091-3095, Copyright © 1998 by Oxford University Press
V Schwenger and E Ritz
Background. Recently, intensified antihypertensive
treatment has been recommended for patients with proteinuric renal disease,
and a target blood pressure of 125/75 mmHg has been proposed.
Methods. In a retrospective crossectional study, all
consecutive patients with renal disease and reduced GFR seen in the renal
outpatient clinic Heidelberg during a specified time period were analysed.
Physicians administered antihypertensive agents according to their clinical
judgment aware of recent recommendations, but without structured
guidelines. The aims of the study were: (i) to monitor achieved blood
pressure (clinic measurement, self measurement, ambulatory BP measurement);
(ii) to monitor the number of antihypertensive medications required; and
(iii) to analyse the factors which determine achieved blood pressure and
the number of antihypertensive agents required. Results.
There were 201 non-transplanted patients, median age 60 years
(range 20-86), 131 male, 70 female, median S-creatinine 2.33 mg/dl
(1.4-10.9). Fifty-two of the patients had diabetes, 41 GN, 18 ADPKD, 17
vasculitis, seven reflux nephropathy, three analgesic nephropathy and 63
other or unknown renal diseases. When the patients had originally been
referred to the renal clinic, median clinic BP had been 160 mmHg systolic
(104-260) and 95 mmHg diastolic (65-160). Under nephrological care,
achieved clinic systolic (140; 90-190) and diastolic BP values (85; 45-130)
were significantly (P<0.0001) lower. Achieved
BP was slightly (r=0.23,
P<0.05) correlated with age, was not
significantly different between genders, and was not correlated to
proteinuria, serum creatinine, renal disease or BMI. Average self measured
BP values were not different from systolic and diastolic clinic BP values.
Ambulatory BP values, however, were significantly
(P<0.0001) lower, e.g. daytime systolic BP 133
mmHg (107-171), diastolic 82 mmHg (65-97). A night-time decrease of
BP⩾15% was seen in 18/25 patients only. The median number of
antihypertensive classes required was 3 (range 1-70 in non-diabetic and 3.5
(1-7) in diabetic patients, respectively. The number of antihypertensive
classes was independent of serum creatinine, BMI or proteinuria, but was
significantly (P<0.01) higher in males (4; 1-7)
than in females (3; 1-6) and correlated to age 9r=27,
P<0.01). Conclusions. The
study (i) illustrates the difficulty to achieve recommended target BP in
patients with renal failure, (ii) shows remarkably little white coat effect
on clinic blood pressure, (iii) illustrates the value of ambulatory blood
pressure measurement and (iv) documents the importance of multidrug
antihypertensive treatment in patients with renal failure.
Keywords: blood pressure; renal failure;
antihypertensive treatment; ACE inhibitors; calcium channel blockers;
progression of renal failure
ORIGINAL ARTICLES
Audit of antihypertensive treatment in patients with renal failure
Department Internal Medicine, Ruperto Carola University of Heidelberg, Bergheimer Strasse 56a, D-69115 Heidelberg, Germany; Corresponding author
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