Document Detail

Hypertension management in chronic kidney disease: translating guidelines into daily practice.
MedLine Citation:
PMID:  21319133     Owner:  NLM     Status:  MEDLINE    
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.
Luca De Nicola; Silvio Borrelli; Paolo Chiodini; Pasquale Zamboli; Carmela Iodice; Francis B Gabbai; Giuseppe Conte; Roberto Minutolo
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of nephrology     Volume:  24     ISSN:  1724-6059     ISO Abbreviation:  J. Nephrol.     Publication Date:    2011 Nov-Dec
Date Detail:
Created Date:  2011-11-07     Completed Date:  2012-04-18     Revised Date:  2012-04-27    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  733-41     Citation Subset:  IM    
Division of Nephrology, Second University of Naples, Naples, Italy.
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MeSH Terms
Antihypertensive Agents / pharmacology,  therapeutic use*
Blood Pressure / drug effects,  physiology
Chronic Disease
Cohort Studies
Follow-Up Studies
Glomerular Filtration Rate / drug effects,  physiology
Hypertension / drug therapy*,  epidemiology*
Kidney Diseases / epidemiology*
Longitudinal Studies
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Regression Analysis
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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