Key result
The frequency of strict blood pressure control (<130/80 mmHg) in hypertensive patients with renal diseases significantly increased from 11.8% in 1996 to 28.9% in 2003.
Why the study?
Does contemporary hypertension management (2003) improve blood pressure control in hypertensive patients with renal disease compared to historical management (1996)?
Cross-Sectional (n=958)
No
Does contemporary hypertension management (2003) improve blood pressure control in hypertensive patients with renal disease compared to historical management (1996)?
Absolute Event Rate: 28.9% vs 11.8%
p-value: p=<0.01
Blood pressure control in hypertensive patients with renal disease significantly improved from 1996 to 2003, likely reflecting increased physician adherence to stricter guideline targets and greater use of ARBs.
Indicates progress toward guideline targets in renal hypertension; supports consensus yet leaves causal outcome effects open in observational data.
For hypertensive patients with renal diseases (RD), strict blood pressure (BP) control has been recommended in recent hypertension guidelines, such as JNC VI, JNC 7, WHO/ISH 1999 and ESH-ESC 2003. We assessed the current status of BP control and the changes of BP control before and after the publication of these guidelines in 489 hypertensive patients with or without RD (age, 19-89 years, mean 59+/-13 years) who visited the hypertension and kidney outpatient clinic at Kyushu University Hospital. The clinical characteristics of RD and non-RD patients were assessed (RD patients: age, 20-89 years, mean 60+/-13 years, n=311; non-RD patients: age, 19-86 years, mean 58+/-13 years, n=178). In addition, we compared the BP control status in 2003 to that in 1996. In 2003, the BP in RD patients was 134+/-16/78+/-10 mmHg and that in non-RD patients was 138+/-12/83+/-9 mmHg. When strict BP control was defined as <130/80 mmHg, the frequency of strict BP control in RD patients was 28.9% in 2003. In addition, the BP levels of RD patients in 2003 were significantly lower than those in 1996 (134+/-16/78+/-10 mmHg vs. 141+/-17/85+/-10 mmHg, p<0.05 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]), and the frequency of strict BP control in RD patients was higher in 2003 than in 1996 (28.9% vs. 11.8%, p<0.01). The BP levels of non-RD patients in 2003 tended to be lower than those in 1996 (138+/-12/83+/-9 mmHg vs. 141+/-13/85+/-9 mmHg, n.s.). In 2003, angiotensin II receptor blockers (ARBs) were more frequently prescribed to RD patients than to non-RD patients. Furthermore, the use of ARBs was markedly increased in 2003 compared with 1996. In conclusion, in our outpatient clinic, BP levels in hypertensive patients with RD have improved in recent years, and were lower than those in hypertensive patients without RD, which may in part reflect the physicians' awareness of the importance of strict BP control in RD patients, as suggested by several recent hypertension guidelines.
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Ohta et al. (2007) conducted a cross-sectional in Hypertension with or without renal diseases (n=958). Hypertension management in 2003 (post-guidelines) vs. Hypertension management in 1996 (pre-guidelines) was evaluated on Frequency of strict blood pressure control (<130/80 mmHg) in patients with renal diseases (p=<0.01). The frequency of strict blood pressure control (<130/80 mmHg) in hypertensive patients with renal diseases significantly increased from 11.8% in 1996 to 28.9% in 2003.
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