Akihiro Tsuchimoto1, Shigeru Tanaka1, Hiromasa Kitamura1, Hiroto Hiyamuta1,2, Kazuhiko Tsuruya1,3, Takanari Kitazono1, Toshiaki Nakano4. 1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 2. Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 3. Department of Nephrology, Nara Medical University, Nara, Japan. 4. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. nakano.toshiaki.455@m.kyushu-u.ac.jp.
Abstract
BACKGROUND: Hypertension is an important prognostic predictor in patients with chronic kidney disease (CKD), and the recommended target blood pressure has been continuously revised. This study aimed to reveal the current antihypertensive practices in Japanese patients with CKD. METHODS: In the Fukuoka Kidney disease Registry, we extracted 3664 non-dialysis-dependent patients with CKD. Apparent treatment-resistant hypertension (aTRH) was defined as a failure of blood-pressure control treated with three antihypertensive medication classes or a treatment with ≥ 4 classes regardless of blood pressure. The blood-pressure control complied with the target blood pressure recommended by the KDIGO 2012 guideline. RESULTS: The median age of the patients was 67 years, body mass index (BMI) was 23 kg/m2, and estimated glomerular filtration rate (eGFR) was 40 mL/min/1.73 m2. The number of patients with unachieved blood-pressure control was 1933, of whom 26% received ≥ 3 classes of antihypertensive medications. The first choice of medication was renin-angiotensin system inhibitors, followed by calcium-channel blockers. The rate of thiazide use was low in all CKD stages (3-11%). The prevalence of aTRH was 16%, which was significantly associated with BMI (odds ratio [95% confidence interval] per 1-standard deviation change, 1.38 [1.25-1.53]), decreased eGFR (1.87 [1.57-2.23]), as well as age, diabetes mellitus, and chronic heart disease. CONCLUSIONS: Renal dysfunction and obesity are important risk factors of aTRH. Even under nephrologist care, most patients were treated with insufficient antihypertensive medications. It is important to prescribe sufficient classes of antihypertensive medications, including diuretics, and to improve patients' lifestyle habits.
BACKGROUND: Hypertension is an important prognostic predictor in patients with chronic kidney disease (CKD), and the recommended target blood pressure has been continuously revised. This study aimed to reveal the current antihypertensive practices in Japanese patients with CKD. METHODS: In the Fukuoka Kidney disease Registry, we extracted 3664 non-dialysis-dependent patients with CKD. Apparent treatment-resistant hypertension (aTRH) was defined as a failure of blood-pressure control treated with three antihypertensive medication classes or a treatment with ≥ 4 classes regardless of blood pressure. The blood-pressure control complied with the target blood pressure recommended by the KDIGO 2012 guideline. RESULTS: The median age of the patients was 67 years, body mass index (BMI) was 23 kg/m2, and estimated glomerular filtration rate (eGFR) was 40 mL/min/1.73 m2. The number of patients with unachieved blood-pressure control was 1933, of whom 26% received ≥ 3 classes of antihypertensive medications. The first choice of medication was renin-angiotensin system inhibitors, followed by calcium-channel blockers. The rate of thiazide use was low in all CKD stages (3-11%). The prevalence of aTRH was 16%, which was significantly associated with BMI (odds ratio [95% confidence interval] per 1-standard deviation change, 1.38 [1.25-1.53]), decreased eGFR (1.87 [1.57-2.23]), as well as age, diabetes mellitus, and chronic heart disease. CONCLUSIONS: Renal dysfunction and obesity are important risk factors of aTRH. Even under nephrologist care, most patients were treated with insufficient antihypertensive medications. It is important to prescribe sufficient classes of antihypertensive medications, including diuretics, and to improve patients' lifestyle habits.
Authors: K Yamagata; K Ishida; T Sairenchi; H Takahashi; S Ohba; T Shiigai; M Narita; A Koyama Journal: Kidney Int Date: 2006-11-22 Impact factor: 10.612
Authors: George Thomas; Dawei Xie; Hsiang-Yu Chen; Amanda H Anderson; Lawrence J Appel; Shirisha Bodana; Carolyn S Brecklin; Paul Drawz; John M Flack; Edgar R Miller; Susan P Steigerwalt; Raymond R Townsend; Matthew R Weir; Jackson T Wright; Mahboob Rahman Journal: Hypertension Date: 2015-12-28 Impact factor: 10.190
Authors: Alfred K Cheung; Tara I Chang; William C Cushman; Susan L Furth; Joachim H Ix; Roberto Pecoits-Filho; Vlado Perkovic; Mark J Sarnak; Sheldon W Tobe; Charles R V Tomson; Michael Cheung; David C Wheeler; Wolfgang C Winkelmayer; Johannes F E Mann Journal: Kidney Int Date: 2019-05 Impact factor: 10.612
Authors: Rikki M Tanner; David A Calhoun; Emmy K Bell; C Barrett Bowling; Orlando M Gutiérrez; Marguerite R Irvin; Daniel T Lackland; Suzanne Oparil; David Warnock; Paul Muntner Journal: Clin J Am Soc Nephrol Date: 2013-07-18 Impact factor: 8.237
Authors: Alfred K Cheung; Tara I Chang; William C Cushman; Susan L Furth; Fan Fan Hou; Joachim H Ix; Gregory A Knoll; Paul Muntner; Roberto Pecoits-Filho; Mark J Sarnak; Sheldon W Tobe; Charles R V Tomson; Lyubov Lytvyn; Jonathan C Craig; David J Tunnicliffe; Martin Howell; Marcello Tonelli; Michael Cheung; Amy Earley; Johannes F E Mann Journal: Kidney Int Date: 2021-03 Impact factor: 10.612