| Hypertension management in chronic kidney disease: translating guidelines into daily practice. | |
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MedLine Citation:
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PMID: 21319133 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Whether nephrology management improves over time achievement of blood pressure (BP) goal (<130/<80 mm Hg) in nondialysis CKD is still ill-defined. This historical cohort analysis evaluated the relationship between 1-year nephrology management and BP control in 275 incident CKD patients in an academic renal clinic. METHODS: Comparative analysis between referral and month-12 visit. RESULTS: Estimated glomerular filtration rate (GFR) was 42.1 ± 15.5 ml/min per 1.73 m2 and median proteinuria 0.20 g/24 hours. From baseline to month-12 visit, BP decreased from 148 ± 23 / 81 ± 12 mm Hg to 136 ± 18 / 76 ± 11 mm Hg, with BP goal prevalence increasing from 13.8% to 33.8%. We stratified patients into at-goal and not-at-goal on the basis of month-12 BP levels. Regression analysis identified diabetes (odds ratio [OR] = 1.96; 95% confidence interval [95% CI], 1.07-3.56) and basal systolic BP (OR=1.12; 95% CI, 1.03-1.21) as independent predictors of not-at-goal BP. The decrease in systolic/diastolic BP was smaller in not-at-goal versus at-goal patients (-7/3 mm Hg vs. -21/9 mm Hg); in not-at-goal reduction was, however, significant versus baseline (p<0.001) and coupled with a similar decline in proteinuria (p<0.001). CONCLUSIONS: Sustained nephrology management improves hypertension control in CKD, but achievement of BP goals remains suboptimal, with high systolic BP and diabetes being the main problems. Further studies are needed to verify the clinical significance of BP and proteinuria changes in patients whose BP remains above target levels. |
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Authors:
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Luca De Nicola; Silvio Borrelli; Paolo Chiodini; Pasquale Zamboli; Carmela Iodice; Francis B Gabbai; Giuseppe Conte; Roberto Minutolo |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of nephrology Volume: 24 ISSN: 1724-6059 ISO Abbreviation: J. Nephrol. Publication Date: 2011 Nov-Dec |
Date Detail:
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Created Date: 2011-11-07 Completed Date: 2012-04-18 Revised Date: 2012-04-27 |
Medline Journal Info:
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Nlm Unique ID: 9012268 Medline TA: J Nephrol Country: Italy |
Other Details:
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Languages: eng Pagination: 733-41 Citation Subset: IM |
Affiliation:
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Division of Nephrology, Second University of Naples, Naples, Italy. luca.denicola@unina2.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Antihypertensive Agents / pharmacology, therapeutic use* Blood Pressure / drug effects, physiology Chronic Disease Cohort Studies Comorbidity Female Follow-Up Studies Glomerular Filtration Rate / drug effects, physiology Humans Hypertension / drug therapy*, epidemiology* Kidney Diseases / epidemiology* Longitudinal Studies Male Middle Aged Practice Guidelines as Topic Prospective Studies Regression Analysis Retrospective Studies Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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