Nephrol Dial Transplant (2000) 15: 440-441
© 2000 European Renal Association-European Dialysis and Transplant Association
Letters
How good are nephrologists at controlling blood pressure in renal patients?
Renal Unit, Nottingham City Hospital, Nottingham NG5 1PB, UK
Sir,
Dr Maschio's recent editorial [1] coincided with the publication of our confidential enquiry on the management of hypertension in patients with chronic renal failure [2]; the findings provide further evidence that the answer to his question is `not very'.
Briefly, the medical records (from both general practice and hospital clinics) of all the 145 patients who started dialysis in Nottingham (population 650000) during 3 years were examined. Altogether 107 patients had been hypertensive; the median time from the diagnosis of hypertension to the start of dialysis was 7.4 years with a mean of five blood pressure recordings per year. There were shortcomings in all aspects of the management of hypertension. To summarize the findings on blood pressure control: the mean of all systolic readings was 159±14 mmHg and the mean diastolic 91.0±7 mmHg; in the last 12 months before dialysis the mean diastolic pressure was significantly lower at 86.4±9 mmHg and the percentage of patients with a mean diastolic blood pressure below 90 mmHg had increased from 45% to 73%. There was no improvement in control of systolic blood pressure. The strict target of 130/85 which is now recommended by the British Hypertension Society [3] was achieved in only 5% throughout the last 12 months.
This longitudinal study from Nottingham confirms the findings of the cross-sectional study of blood pressure control from Heidelberg [4]. It also draws attention to shortcomings in other aspects of the management of these patients. The advantages of meticulous blood pressure control are well established but there is a lot of work to be done in putting this into practice. It needs the commitment of both nephrologist and other physicians and perhaps patients need more detailed explanations about the importance of careful blood pressure control and greater involvement in their care with, for example, home monitoring. Other measures such as an occasional echocardiographic estimate of left ventricular hypertrophy may help to confirm the quality of overall blood pressure control in much the same way as glycosylated haemoglobin provides an overall picture of glycaemic control in diabetes.
References
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Maschio G. How good are nephrologists at controlling blood pressure in renal patients? Nephrol Dial Transplant 1999; 14: 2075–2077
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Dasgupta I, Madeley RJ, Pringle MAL, Savill J, Burden RP. Management of hypertension in patients developing end-stage renal failure. Q J Med 1999; 92: 519–525
[Abstract/Free Full Text] - Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter JF, Poulter NR, Russell G. Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Human Hypertension 1999; 13: 569–592[Web of Science][Medline]
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Schwenger V, Ritz E. Audit of antihypertensive treatment in patients with renal failure. Nephrol Dial Transplant 1998; 13: 3091–3095
[Abstract/Free Full Text]
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