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Titolo:
Audit of antihypertensive treatment in patients with renal failure
Autore:
Schwenger, V; Ritz, E;
Indirizzi:
Univ Heidelberg, Dept Internal Med, D-69115 Heidelberg, Germany Univ Heidelberg Heidelberg Germany D-69115 , D-69115 Heidelberg, Germany
Titolo Testata:
NEPHROLOGY DIALYSIS TRANSPLANTATION
fascicolo: 12, volume: 13, anno: 1998,
pagine: 3091 - 3095
SICI:
0931-0509(199812)13:12<3091:AOATIP>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
BLOOD-PRESSURE CONTROL; DIABETIC NEPHROPATHY; PROTEIN RESTRICTION; PROGRESSION; INSUFFICIENCY; DISEASE;
Keywords:
blood pressure; renal failure; antihypertensive treatment; ACE inhibitors; calcium channel blockers; progression of renal failure;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Schwenger, V Univ Heidelberg, Dept Internal Med, Bergheimer Str 56A, D-69115 Heidelberg, Univ Heidelberg Bergheimer Str 56A Heidelberg Germany D-69115
Citazione:
V. Schwenger e E. Ritz, "Audit of antihypertensive treatment in patients with renal failure", NEPH DIAL T, 13(12), 1998, pp. 3091-3095

Abstract

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 unknownrenal diseases. When the patients had originally been referred to the renal clinic, medianclinic 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 greater than or equal to 15% was seen in 18/25 patients only. The median number of antihypertensive classes required was 3 (range 1-7) in non-diabetic and 3.5 (1-7) in diabetic patients, respectively. The numberof 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 (r = 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 12:51:16