Document Detail

Management of hypertension in patients with CKD: differences between primary and tertiary care settings.
MedLine Citation:
PMID:  15983953     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although most patients with moderate chronic kidney disease (CKD) are managed exclusively in primary care (PC), no data on blood pressure (BP) control in this setting are available. We compared hypertension management in patients with CKD followed up in PC and nephrology tertiary care (TC). METHODS: We studied hypertensive patients with estimated glomerular filtration rates (eGFRs) of 15 to 60 mL/min/1.73 m2 (0.25 to 1.00 mL/s) exclusively followed up for at least 1 year in PC (n = 259) or TC (n = 186). RESULTS: PC compared with TC patients were characterized by older age (73 +/- 10 versus 65 +/- 14 years; P < 0.0001), greater prevalences of previous cardiovascular events (59% versus 32%; P < 0.0001) and diabetes (36% versus 23%; P = 0.005), and slightly greater eGFRs (37 +/- 10 versus 34 +/- 11 mL/min/1.73 m2 ; P = 0.005). They showed higher BP levels (143 +/- 15/82 +/- 7 versus 136 +/- 18/78 +/- 11 mm Hg; P < 0.0001), with a lower prevalence of BP target (5.8% [95% confidence interval (CI), 2.9 to 8.6] versus 21.5% [95% CI, 15.6 to 27.4]; P < 0.0001). The risk for not achieving BP target in PC was 2.6 times greater, independently from age, sex, diabetes, and eGFR. Fewer antihypertensive drugs were prescribed in PC (1.9 +/- 1.1 versus 2.5 +/- 1.1; P < 0.0001). In both groups, inhibitors of the renin-angiotensin system were the most frequently prescribed drugs (>84%), followed by diuretics (50%). However, family physicians almost exclusively prescribed hydrochlorothiazide, whereas nephrologists preferentially prescribed furosemide, administered at a higher dose than in PC (47 +/- 41 versus 28 +/- 21 mg/d; P = 0.004). CONCLUSION: Control of CKD-related hypertension is significantly worse in PC despite a greater cardiovascular risk. Barriers to optimal BP control likely are represented by a low number of drugs and inadequate diuretic therapy.
Roberto Minutolo; Luca De Nicola; Pasquale Zamboli; Paolo Chiodini; Giuseppe Signoriello; Clemente Toderico; Gennaro Arfè; Giuseppe Boschi; Ciro Brancati; Patrizia Iaccarino; Giuseppe Conte
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  46     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-28     Completed Date:  2005-11-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-25     Citation Subset:  IM    
Department of Nephrology, Second University of Naples, Naples, Italy.
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MeSH Terms
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antihypertensive Agents / therapeutic use*
Calcium Channel Blockers / therapeutic use
Cardiovascular Diseases / epidemiology
Case Management*
Chronic Disease
Cohort Studies
Creatinine / blood
Diuretics / therapeutic use
Drug Utilization / statistics & numerical data
Furosemide / therapeutic use
Glomerular Filtration Rate
Hydrochlorothiazide / therapeutic use
Hypertension / drug therapy*,  etiology
Hypertension, Renal / drug therapy,  etiology
Italy / epidemiology
Kidney Diseases / complications*,  physiopathology
Middle Aged
Nephrology / methods*,  statistics & numerical data
Outpatient Clinics, Hospital / statistics & numerical data*
Primary Health Care / methods*,  statistics & numerical data
Risk Factors
Sodium Chloride Symporter Inhibitors / therapeutic use
Treatment Outcome
Urban Population
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Diuretics; 0/Sodium Chloride Symporter Inhibitors; 54-31-9/Furosemide; 58-93-5/Hydrochlorothiazide; 60-27-5/Creatinine

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

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